What is TAVI/TAVR
- TAVI/TAVR is the percutaneous aortic valve replacement procedure.
- TAVI stands for Transcatheter Aortic Valve Implantation and TAVR stands for Transcatheter Aortic Valve Replacement.
- This procedure is done to replace the disease aortic valve, mainly severely stenosed aortic valve.
- This is done as an alternative to surgical aortic valve replacement.
What is severe aortic stenosis?
- Severe aortic stenosis prevents your aortic
- valve leaflets from opening and closing
- properly. This makes your heart work harder to pump blood to the rest of your body.
- A diseased valve affects your health and
- limits your daily activities.
Causes of Aortic Stenosis:
- Calcium build-up
- Radiation therapy
- Infection of the heart
- Chest pain
- Out of breath
- Irregular heart beatMedication
Common treatment options :
- Certain medications may ease some severe aortic stenosis symptoms.
Balloon Valvuloplasty (BAV)
- A tiny balloon is inflated in the aortic valve to try and improve blood flow,
- but this treatment typically provides only temporary relief.
Surgical Aortic Valve Replacement (SAVR)
Open heart surgery is done to remove the damaged valve and replace it with an artificial valve. Patients usually need to stay in the hospital for a week or more, before beginning a long period of recovery.
Trans catheter Aortic Valve Replacement (TAVR)
TAVR is less invasive than open-heart surgery. Your doctor will make a small incision on your body. After, a thin, flexible tube is inserted into an artery to guide the artificial heart valve up to your heart to replace the diseased valve.
What are the best treatment options for you?
Your heart team will conduct some tests to help determine the best treatment plan for you. These tests will tell your doctor:
- The shape and size of your heart
- The structure of your artery system
- If you have other medical problems
Common tests performed in the valve clinic:
- Cardiac catheterization
- CT scan
- Carotid ultrasound
- Blood tests
- Physical exam
- Frailty testing
- The TAVR heart valve can be a balloon expanding valve or self-expanding valve, made up of a metal frame with leaflets and an outer wrap made from animal tissue. It is designed to work like your own heart valve.
- Your doctor will help you decide which TAVR heart valve is right for you.
- Your heart team will determine whether you should have a mild sedative or general anaesthesia.
- At the start of the procedure, your doctor will make a small puncture or cut in the groin, or the neck or space between your ribs, and guide a thin flexible tube with the heart valve into your artery and up to your diseased valve. Throughout your procedure, your doctor will be viewing images of your heart.
- The TAVR heart valve will be placed in your diseased valve. Your new valve will work immediately. Your doctor will remove the tube and close the incision. The entire procedure typically takes approximately one to two hours.
After your procedure, you may spend a day or more in the ICU (intensive care unit) and you will be closely monitored here and will undergo a detailed physical examination involving some blood test, a chest X-ray, egg, and echocardiogram after 24 hours of procedure to ensure the proper recovery. Once you are stable, you will be transferred to the patient room where you will be kept for another day or two. Most patients begin walking within a day of their TAVR procedure.
Before you leave the hospital, your doctor will explain what kinds of activities you can do, if you need to take medication and when you will need to see your doctor again.
You will also be given a card with information about your TAVR heart valve. Share this card with your family members and all members of your healthcare team, including your dentist. If you need an MRI, tell your doctor that you have a TAVR heart valve.
Recovery Period after Discharge
Care for the Procedure Site:
Carefully inspect the site daily, being sure to first wash your hands. If the procedure is percutaneous (through the skin) you can take a shower from the next day only, if the procedure needs a small incision (if in case) then your doctor will instruct you to shower depending on your procedure site status. Keep the site clean and dry. Do not apply lotions, powders, or ointments.
Do not leave the bandage dressing for more than a day on the site.
If the access site was the groin (transfemoral):
There may be some bruising and tenderness at the access site, which is expected and normal. You may notice a small lump in the groin which will dissolve on its own in about 4-6 weeks.
If the access site required an incision under the clavicle or between the ribs:
Expect a small amount of firm tissue, tenderness, and bruising at the incision site, which is normal. You may have staples at the incision site and will be instructed when to return to have them removed.
Immediately call your doctor or go to the closest emergency room if you notice:
- Bleeding or discharge at the site
- Unusual or excessive swelling, pain, or redness
- A temperature greater than 101 degrees.
Post Procedure Activity:
- Most of the patients can walk on the same day.
- Avoid lifting heavy objects, excess bending stretches, and push or pull activities for two weeks.
- Walking: Begin by trying to walk for 5 minutes daily after discharge. Then, gradually increase the duration as per your convenience. Ask someone to accompany you during the first few walks.
- Try performing 10 sit-to-stand repetitions daily without hand assistance. Increase to performing this activity 2-3 times per day.
- It is all right to slowly climb stairs.
- If your TAVR was performed through the groin without any incision, you can drive after 5 days.
- Avoid sexual activity until a follow-up appointment with your cardiologist.
- Your doctor will provide a time frame for when you can return to work.
- Your cardiologist may recommend some blood thinners after your TAVR procedure.
- These will most likely include aspirin and clopidogrel.
- Never stop taking any medicine unless the doctor advises doing so as it may cause
- serious medical problems.
TAVR Follow-up Visits
- You will be asked to return to the valve clinic to have your heart valve checked 30 days and one year after your procedure.
- If you have concerns, discomfort or changes in your health, be sure to let your doctor know right away.
What to expect
Most patients start feeling better right away, but it can take a little longer for others. Many TAVR patients report benefits like:
- Having more energy
- Being able to do everyday activities
- Breathing normally
- Experiencing less pain
- Feeling less anxious
- You should start feeling better right away.
- This is because your heart valve is now working properly. Some patients may take longer to feel better.
- Most patients felt less pain and less anxious. They could take care of themselves better and go back to everyday activities.
Activity and exercise after complete recovery:
- Begin with regular walking, cycling, or swimming.
- Ideally, 30-minutes of exercise 3-5 times per week is good for the heart.
- Overhead Press Exercise and Wood Chop Exercise. The precise technique of the last
- two exercises can be known by a Gym Trainer or a Physiotherapist.
- Talk to your healthcare provider to know more.
Defining Your Aortic Stenosis Risk
The TAVR procedure is currently approved for patients with severe aortic stenosis who are at intermediate risk, high risk or extreme risk for complications during surgery. Your doctor can determine your risk category based on several
factors including age and other medical conditions that might make surgery more dangerous for you.
The TAVR Valve Should NOT Be Used for Certain People Patients who:
- Have an infection
- Have a mechanical valve
- Cannot take blood-thinning medicines
- React to some metals
- React to some radio-imaging solutions
- Some patients may have a disease that results in more calcium in their blood. This may cause early wear.
- The TAVR valve is only for certain patients. This includes patients with severe aortic stenosis who are at intermediate risk or greater for surgery.
- At some point the TAVR valve may need to be replaced. How long it lasts varies from patient to patient.
- The TAVR valve has been tested to mimic five years of typical use without failure.
Keep appointments with your doctor.
Follow all care instructions to ensure the best possible results.
- Antibiotics may be recommended for patients who are at risk of infections.
- Patients should stay on blood-thinning medicines after the procedure as instructed by your physician. Patients who do not are more likely to have a stroke.
- If you require an MRI scan, tell the doctor that you have a TAVR valve. Not doing so could result in injury or death. Your dentist and all doctors need to know about your TAVR valve.
Difference between mechanical valves and tissue valves :
- Requires INR blood tests – every month
- Anticoagulants (powerful blood thinner)- a must medication for life
- Restrictions – dietary and lifestyle
- Medicine restrictions – more than 150 restrictions
- Pregnancy complications – the risk of pregnancy loss, premature birth and maternal deaths
- INR tests – infrequent monitoring required
- Anticoagulant – no long term use
- Medicine restrictions – no adverse drug interactions
- Pregnancy complications – no known risk of pregnancy complications.
Frequently asked questions :
How do I know if my TAVR heart valve is working properly?
Your doctor will check your valve during your regular follow-up visits.
Is it safe to have an MRI with a TAVR heart valve?
If you need an MRI, tell your doctor that you have a TAVR heart valve. Not doing so could result in injury or death.
What kinds of exercise can I do?
Discuss this with your doctor. He or she can help you decide what activities are safe for you.
Can the TAVR heart valve be used for all patients?
The TAVR heart valve should not be used for patients who:
- Have an infection
- Have a mechanical valve
- Cannot take blood thinners
- React to some metals
- React to some imaging solutions.
What are the risks of the TAVR procedure?
All medical procedures come with risks.
Although serious or major complications from the TAVR procedure are rare, they can include:
- Serious damage to the arteries
- Serious bleeding
- Need for a permanent pacemaker
Q. What should I carry with me to the hospital while going for a TAVR procedure?
- Copy of Mediclaim Policy Identity Card
- The list of ongoing medications with clear dosage recommendations
- Clothes to wear on the day of discharge
- The choice of toiletries
Q. What should I not bring to the hospital while getting admitted for a TAVR procedure?
A. Jewellery or any other valuable goods. Please follow the instructions as provided by the hospital.
Q. Should I bring anyone with me while getting admitted?
A. you can come to the hospital alone. But it is better to be accompanied by a family member or a friend for physical, mental and psychological support during the hospital stay and at discharge.
Q. Will I feel pain during the TAVR operating procedure?
A. You will be given medicines before the procedure due to which you will remain asleep throughout the procedure and ideally won’t feel any pain or discomfort. However, you might feel little pain or tenderness at IV line insertion sites. Inform the staff if it bothers you.
Q. How can a TAVR procedure benefit me?
A. As the TAVR procedure is less invasive, you may be able to return to routine activity more quickly than open-heart surgery. Patients who have undergone a TAVR procedure report an improvement in their quality of life soon after. Other advantages of TAVR include a shorter stay in the hospital, no chest scars, immediate relief of symptoms, improvement of heart function, and decreased pain and anxiety.
Q. How long will my valve last?
A. The life of your TAVR valve depends on numerous factors and differs for each person. However, its functioning can be checked from time to time through regular follow-ups with your doctor.
Q. What is a Heart Team?
A. Heart Team is a group of specialists including interventional cardiologists, cardiac surgeons, radiologists, anesthesiologists, and cath lab staff. All these experts will collectively decide if the TAVR procedure is suited for you or not.
Q. What are the specifications for MRI post TAVR procedure?
A. The TAVI Valve is MRI Conditional. It can be safely scanned under the following specifications :
- Static magnetic fields of 1.5 and 3 Tesla.
- 2500 gauss/cm spatial gradient field.
- Normal operating mode with a maximal whole-body SAR of 2.0 W/Kg for 15
- Minutes as stated on the equipment monitor.
- MRI is not recommended in case you have undergone a TAVR inside an old surgically replaced valve.
Q. Are there any risks involved with the TAVR procedure?
A. As with any other operating procedure, TAVR is also associated with several risks.
The most severe risks with the TAVR procedure include
- Major Stroke
- Major Blood Vessel Complications such as large clot formation under the skin
- Major bleeding events that may prove dangerous to life and need a blood
Other risks include (but are not limited to):
- Heart Attack
- Heart Failure
- Disturbances in your heart’s electrical activity, requiring a pacemaker implantation
- Oedema formation
- Injury to the blood vessel
- Inability or difficulty in Breathing
- Abnormal BP
- Problems at the incision site such as pain or change in skin colour (reversible)
- Valve dysfunction
- Blood leak around the valve
- Additional heart or blood vessel surgery requirement
Q. Can the valves get rusted?
A. No. the metallic portions of the valve are made from corrosion-resistant metals, such as cobalt-nickel alloy which do not react with the body or rust over time.
Q. Will I feel the valve after the procedure?
A. No, the valve will never be felt after placement.
Q. Can I have an X-Ray after the TAVR is in place?
A. Yes. It is very much safe to have X-Ray tests done after the TAVR device is in place.
Q. what are the warnings for a TAVR procedure?
- The implanted valve may not last long in patients who have problems with calcium metabolism in their body.
- Talk to your doctor if you have allergies to any of the components involved with the TAVR devise or procedure.
- X-ray exposure may lead to radiation injury on the skin.
- Confirm with your doctor in advance whether the device is suitable for your condition.
Q. What precautions must be taken once a TAVR heart valve is implanted?
- Patients should be on blood-thinning and other medications after the procedure as instructed. Patients who do not follow this are more likely to get a stroke.
- TAVR patients who are going for a dental procedure should take antibiotics to decrease the chance of getting an infection.
Q. How do I take care of my valve?
- Be sure your dentist and doctors know that you have had a heart valve replacement.
- Ask your dentist and doctor about taking antibiotics before dental or surgical procedures or endoscopy to help prevent valve infection. Always follow your doctor’s instructions carefully.