The TAVI technique is currently one of the most widely used techniques by physicians when replacing the aortic valve by means of a catheter. This valve is a structure located at the outlet of the heart and allows oxygenated blood to flow through it and carry it to the whole organism (the head, the different organs, and the heart itself).
The main problems associated with the valve are:
- It does not open properly (stenosis).
- It does not close completely (insufficiency).
Aortic stenosis is the most common valve disease in the western world and mainly affects the elderly.
The TAVI (Trannscatheter Aortic Valve Implantation) technique has revolutionized surgical interventions by allowing patients to undergo surgery without the complexity of the standard procedure. In the past, patients with associated diseases and advanced age could pose an unacceptable risk for conventional cardiac surgery, and were simply rejected as candidates for classic surgery or underwent surgery, sometimes with an unfavorable outcome due to their high risk.
But TAVI has managed to reduce the risk that the patient assumes when entering the operating room, since through an arterial puncture, which in most cases is done via the transfemoral route, the vessel is cannulated and advancing up to the heart. At that level, when the diseased valve is reached, the valve is deployed following a process similar to the placement of a stent; that is to say, it is folded inside a catheter (a thin tube-shaped structure).
This procedure “imprisons” the remains of the native valve (which is degenerated and calcified), with the prosthesis that we place. In this way, the prosthesis is fixed to the remains of the patient’s native valve.
Advances in TAVI
This technique initially allowed patients with a formal contraindication to open surgery, who presented an unacceptable risk due to their associated pathology or advanced age that did not recommend classic surgery, to be operated on the diseased valve.
Nowadays, the TAVI technique is being progressively extended to other patients at lower risk, having demonstrated similar or better results to open surgery in certain types of patients.
In addition to reducing the risk and complications derived from the intervention, this technique shortens the patient’s hospitalization time. Conventional surgery, however, involves an average stay of 8-10 days, with 3-5 days in the ICU. Currently, we are offering our patients an average stay of 1 day in the ICU and another on the ward, and most of them are discharged within 48 hours.
What complications are there?
Complications are extremely rare. They could be local at the access site and even rarer at the cardiac level. Most of the procedures are performed via the femoral route and in our group this access is always our bet. This allows us to work through a puncture, unlike other accesses of this technique, which are usually through an incision, such as the subclavian (below the clavicle) or carotid (in the neck).
As we said, there are other much rarer complications located at the cardiac level, which are very rare and would require the classic and emergent opening of the thorax. Both classic surgery and TAVI can produce a low percentage of heart rate slowing, requiring pacemaker implantation in isolated cases. This percentage is somewhat higher in some TAVI valve models.
In conclusion and in general terms, aortic valve replacement using the TAVI technique has been a revolution in this procedure, having simplified it and which can progressively benefit more patients.