Transcatheter Aortic Valve Implantation (TAVI), also referred to as percutaneous aortic valve replacement, is a minimally invasive procedure to treat severe symptomatic aortic stenosis. This is a condition where the heart’s aortic valve becomes narrowed or obstructed, preventing it from opening properly and blocking the flow of blood from the left lower chamber of the heart to the aorta. In this procedure, the diseased aortic valve is replaced to restore normal blood flow.
In the early stages, patients with severe aortic stenosis may have no symptoms but as the disease progresses, classical symptomatic of breathlessness on exertion, chest pain and syncope heralds and more sinister prognosis.
Degenerative aortic stenosis is associated with aging. Unfortunately, no therapy has been proven to alter the rate of progression of aortic stenosis.
Degenerative aortic stenosis increases in incidence with aging with patient presenting with symptomatic aortic stenosis above 80 years old. Congenital malformation of the aortic valve such as bicuspid aortic valve accelerates degeneration of the aortic valve and presents about 10 years earlier compared to normal trileaflet aortic valve. Less common risk factors include rheumatic heart disease, chronic renal failure and prior radiotherapy to the chest.
Aortic stenosis can be picked up in its asymptomatic stage when an ejection systolic murmur is heard classically radiating to the carotid artery with a crescendo decrescendo manner best heard over the left sternal edge. Patients can present with symptoms and subsequent found to have a systolic murmur present. Transthoracic echocardiogram confirms the presence of aortic stenosis and assesses the severity as well as underlying cause of aortic stenosis. If the diagnosis is in doubt, invasive measurement of the aortic valve gradient can be measured with cardiac catheterisation.
If TAVI is considered as therapy for high risk surgical patients for treatment of aortic stenosis, a Computed Tomography (CT) scan will be done prior to TAVI to assess suitability and help plan the approach and type of TAVI valve to be used. Coronary angiogram will be performed prior to TAVI and significant coronary stenosis treated first to improve safety prior to TAVI. Dental clearance will also need to be done prior to TAVI to reduce the risk of infective endocarditis.
Patient after a successful TAVI procedure will be monitored in hospital for complications, assessed for the correct function of the newly implanted TAVI and ambulated back to their baseline ambulation status prior to discharge which usually is within a week of the TAVI procedure. After TAVI, aspirin and clopidogrel will be prescribed for 3-6 months. Patients can generally resume normal activities after 1 week. Good dental hygiene needs to be maintained and patients will require antibiotic prophylaxis for invasive dental treatment after TAVI.
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