How to perform TAVI

What is a transcatheter aortic valve replacement (TAVI) procedure?

This minimally invasive technique is usually performed through a small cut in the groin and occasionally through a small cut in the side or front of the chest. Tissue (biological) valve is attached to expandable balloon which is further inserted into a 8-10 mm catheter (a thin and flexible tube). Guided by a catheter, this inflatable balloon is first inserted into aorta through a small cut in the groin. With navigation system, after reaching the location of left ventricle and aortic valve, the artificial valve is then placed in position. The inflatable balloon is used to deploy and lock the valve in place. The catheter is further removed and the new valve works in place of the original valve. By performing this procedure, patients have small incisions in the groins, left chest or upper part of right chest, depending on the location of balloon and valve replacement. Currently, TAVI is predominantly considered as an effective treatment option for patients with aortic valve stenosis, not only limited to patients with moderate and high risks.

The most common sites for arterial access are the groin of the leg, shoulder, arm and wrist. The majority of cases has been performed through femoral artery in the groin  due to its larger diameter, thus a catheter can be inserted quite easily. However, there are some limitations for artery access through the groin such as circulatory problems in which narrowed arteries reduce blood flow to the legs. In such a case, other sites to reach artery is considerably preferred. Time consumption for TAVI is approximately 2 hours.

Special precautions for TAVI include patients with bacterial infections, patients with acute myocardial infarction, cardiac embolism or blood clot, irregular heartbeat such as tachycardia (rapid heart beat), patients who just recovered from stroke with the administration of anticoagulants and patients with coronary artery disease. After TAVI procedure, patients might need a 3-month anticoagulant therapy. Heavy exercise and physical activities that need extreme exertion must be avoided. Full recovery period normally takes only up to 3 months with an ability to return to daily activities with improved quality of life.

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