All About Transcatheter Aortic Valve Implantation (TAVI)

TAVI (transcatheter aortic valve implantation) is an interventional cardiology procedure that allows the implantation of a new aortic valve via a percutaneous approach, as an alternative to open-heart surgery.

Initially indicated for patients with high surgical risk, for example in cases of significant comorbidities, TAVI has in recent years shown results comparable to the traditional surgical technique and has in fact become a viable alternative to it.

In our center, patients with valvulopathies are followed within the framework of a dedicated clinical and care pathway, based on multidisciplinarity and advanced specialization.

Active collaboration between interventional cardiologists and cardiac surgeons ensures that all patients with aortic valvulopathy receive the most personalized and optimized treatment possible.

In fact, all patients candidates for TAVI surgery must undergo preliminary examinations which generally include:

• a three-dimensional echocardiography;
• cardiac computed tomography angiography;

The collegial review of these examinations allows not only the choice of the most suitable aortic prosthesis for the patient, but also the precise planning of technical solutions, such as the choice of access route, which appear most favorable to the success of the procedure.

Procedure for Percutaneous Aortic Valve Implantation (TAVI)

TAVI is a procedure performed by interventional cardiologists, i.e., cardiologists specializing in minimally invasive procedures such as coronary angioplasty. For this type of intervention, cardiologists work in collaboration with cardiac surgeons who perform much more invasive heart operations (such as coronary artery bypass grafting). Teamwork is important to correctly identify patients who can undergo this type of intervention and to resolve any complications related to the operation.

Percutaneous aortic valve implantation (TAVI) is generally performed under sedation – although general anesthesia may sometimes be necessary – using femoral artery access in the groin.

In some cases, the valve is dilated using a special balloon to facilitate subsequent prosthesis implantation.

The prosthesis is a biological valve made of pericardium, the membrane that covers the heart, mounted on an expandable steel support (stent) and implanted above the original aortic valve, so that the valve problem is definitively resolved.

Post-operative Care for Percutaneous Aortic Valve Implantation (TAVI)

While it is not possible to generalize, hospitalization for TAVI averages 5 to 7 days. Upon admission to the hospital, preparation for the intervention must be carried out: blood tests, hydration if necessary, management of medication. After the intervention, a stay in intensive care is planned for at least 24 hours, in order to monitor vital parameters and electrocardiogram. Then, in the absence of complications, the patient can be transferred to the ward or for rehabilitation.

Recovery of functional autonomy, i.e., the ability to get up and move independently, is generally immediate in subjects in good general condition. The aortic is generally performed under sedation – although general anesthesia may sometimes be necessary – using femoral artery access in the groin.

In some cases, the valve is dilated using a special balloon to facilitate subsequent prosthesis implantation.

The prosthesis is a biological valve made of pericardium, the membrane that covers the heart, mounted on an expandable steel support (stent) and implanted above the original aortic valve, so that the valve problem is definitively resolved.

Results of Percutaneous Aortic Valve Implantation (TAVI)

All data agree that TAVI offers comparable and, in some cases, superior clinical results to surgery. This procedure also allows for shorter hospital stays and faster recovery of motor functions than conventional surgery, an aspect that should not be underestimated given the advanced age of most patients with aortic stenosis.

According to the most recent estimates, the complication rate associated with TAVI is less than 1% when considering the most serious events leading to death or the need for urgent open-heart surgery. In studies carried out to date, the percentage of patients who die within 30 days of the operation is 2 to 3%; the probability of a stroke is even lower. The most frequent complications are bleeding at the access site (hematoma, artery rupture) and the appearance of certain cardiac rhythm disorders, which may in some cases require the implantation of a permanent pacemaker.

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Advantages of TAVI

Until about fifteen years ago, surgery was the only chance of salvation for patients with severe aortic stenosis. However, as most of these patients present to the doctor at an advanced age, surgery is very risky in most cases. It involves general anesthesia, extracorporeal circulation and a whole series of procedures that can be complex in elderly patients or those suffering from other diseases. Cardiac surgery has undergone great technological innovation and many procedures are now performed using a minimally invasive approach. However, TAVI is the only minimally invasive procedure that has allowed, since its introduction, the treatment of many patients who were previously left without hope of intervention. Indeed, this type of approach was initially reserved for patients considered inoperable or at very high risk for traditional surgery. A series of studies have evaluated its efficacy and safety in patients with varied clinical characteristics.

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