What is a TAVI procedure?

TAVI, short for Transcatheter Aortic Valve Implantation, is a revolutionary procedure for treating aortic stenosis and helps improve a damaged aortic valve. This minimally invasive procedure has gained a lot of traction over the past few years as it provides an alternative to people for whom other forms of treatment or surgery is no longer an option. People who have undergone TAVI have reported a substantial boost to the quality of their lives. Even for people who are at high risk for open heart surgery, TAVI (also referred to as TAVR) has proven to be a boon as it can be performed through multiple approaches.

What is Aortic Stenosis?

The role of your heart is to pump blood throughout the body – every second of the day – without missing a beat. For doing that efficiently, there are four valves in the heart, one of which is the Aortic heart valve. The Aortic Valve has thin sheets of leaflets or tissues which open and close as and when the heart pumps out blood to regulate the flow of blood. Over time or due to other causes, these leaflets can become rigid resulting in the opening of the valve getting narrowed down.

What this means is that the heart is unable to function optimally as the valves aren't able to open and close as effectively as they are supposed to. This, in turn, adds extra stress on the heart as it has to work harder to pump out blood. When such a scenario plays out, it's a condition which is termed as Aortic valve stenosis or Aortic Stenosis.

Primary Causes of Aortic Stenosis

Aortic Stenosis can occur due to four distinct reasons which are listed as below:

• Congenital defects - Most people are born with three leaflets of tissue surrounding their aortic valve. However, due to congenital defects, some people are born with one or possibly four leaflets. These birth defects can result in several recurring problems with the aortic valve.
• Radiation Therapy - Individuals who have undergone some form of radiation therapy are also susceptible to Aortic Stenosis. It’s been observed that in certain individuals, there’s a development of scar tissue along with inflammation which can cause the aortic valve to stiffen – ultimately resulting in loss of function.
• Build-up of Calcium-Calcium build-up on the leaflets of the valve can result in the stiffening of the leaflets of the valve thus affecting its ability to open and close effectively.
• Rheumatic Fever -  Development of rheumatic fever can result in the formation of scar tissue to form within the heart affecting the aortic valve ability to open and close normally.

How Aortic Stenosis Progresses?

Being a progressive disease, Aortic stenosis tends to worsen as time passes by. Over time, the aortic valve gets narrower and your heart muscle gets weaker as well which can be life-threatening. When the valve becomes diseased, it can cause a variety of symptoms including tiredness and fatigue, difficulties in breathing, pain in the chest region or even blackouts in some severe cases. Further, it’s been reported that nearly 50% of individuals who go on to develop severe aortic stenosis symptoms will lose their lives within an average of two years unless they take corrective action and have their aortic valve replaced.

About the TAVI Procedure

TAVI has gained a lot of popularity over the years as it’s proven to be successful in helping treat scores of individuals suffering from Aortic stenosis and giving them a new lease of life. During a TAVI procedure, an artificial/ prosthetic valve – made of natural animal heart tissue – will be implanted into the diseased aortic valve. While there are multiple approaches for performing TAVI, the most common & popular approach is the Transfemoral approach as it’s also minimally invasive. In this approach, the delivery sheath is inserted usually through a catheter via the femoral artery in the patient’s groin. In most cases, only a small incision is required in the groin. The TAVI valve then is pushed upwards through the artery until it reaches the aortic valve. Once the new valve has been placed, it expands thus pushing the old valve leaflets out of the way while the new tissue in the replacement valve takes over the responsibility of systematically regulating the blood flow. Finally, the small incision made in the groin is sealed.

Then there’s the Transapical approach where TAVI is performed through a small incision in the chest thus providing direct access to the heart. Next, the delivery sheath is placed in the heart’s apex following which the TAVI valve is inserted. The third approach is the Transaortic approach where a small incision is made near the breast bone and the delivery sheath is pushed into the aorta.

It needs to be mentioned that TAVI is not suitable for all individuals. During the consultation process, the cardiac surgeon, as well as a cardiologist, will analyze the patient's suitability and then accordingly determine the best possible course of action in his/her case. Accordingly, a series of tests will be performed to evaluate whether the procedure is suitable which includes Clinical Examination, Echocardiogram, CT scan, and Cardiac Catheterization.

Why Should I Opt for a TAVI procedure?

Around the world, TAVI has delivered outstanding patient outcomes. Here are some eye-opening statistics to drive home the point:

• Patients have experienced 99.2 percent freedom from disabling stroke within just 30 days of the procedure.
• Survival rates have shot up to 98.4 percent after just 30 days of undergoing the procedure.

Moreover, being a minimally invasive interventional (non-surgical) technique which is performed in a catheterization laboratory – similar to Angioplasty – a TAVI procedure (in most cases) doesn’t require a big incision running vertically across the chest. This means it's not only safer and a low health risk alternative but also results in less scarring as compared to a conventional Open Heart Surgery. The biggest distinction is that this procedure can also be performed under mild sedation which entails that the patient doesn’t require hours of being under general anaesthesia.

What happens after a TAVI procedure?

Upon completion of the TAVI procedure, our doctors will monitor your condition closely and check if the recovery is going as per schedule. Before getting discharged, you will be informed about the precautionary steps along with detailed instructions that you will need to follow to ensure that you get up and running within no time. Needless to say, our team will be there supporting you during this recovery period every step of the way.

Recovery period

In most cases, barring any complications, you will remain in the intensive care unit for a maximum of 1 – 2 days for monitoring. Following that, you will be transferred to another unit where your recovery will be closely monitored for over a week. Full recovery usually takes up to 2 months, following which you will be able to return to your day-to-day activities.

TAVI at Fortis

At Fortis, our multi-disciplinary team comprising of world-class cardiologists, cardiothoracic surgeons, radiologists, anaesthetists, geriatricians, physiotherapists, intensive care specialists, nursing staff and other support staff have years of experience in successfully performing this advanced surgical procedure. Fortis has invested in advanced imaging technology and state-of-the-art equipment to ensure excellent results for our patients. We deliver a full-suite of complete heart-care services including:

• Emergency Angioplasty
• Coronary Angiography, Angioplasty, Stenting, IVUS & Rotablation
• Heart Failure Device and AICD Implantation
• ASD, VSD and PDA device closure
• Peripheral Angioplasty & Stenting (Carotid / Iliac / Femoral / Subclavian / Aorta)
• EP Studies / RF Ablation
• Valvuloplasties, Valve Repair, and Replacement
• On and Off-Pump Cardiac Surgeries
• TAVI Procedure

TAVI procedures entail a high amount of expertise, knowledge, and care which is why our team sits down with every patient and reviews each case personally to determine their suitability for the procedure. Our selective patient selection process has allowed us to achieve the best results along with the exceptional patient outcomes for all our patients. However, at this time, this procedure has been earmarked only for senior citizens who aren’t eligible for an open heart surgical procedure due to high risk or other reasons. Individuals who previously had an artificial bio-prosthetic aortic valve inserted and which over time has degenerated are also eligible to get a TAVI procedure done without requiring the need to redo an open heart surgery.