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Dr Diana R Holdright
MD, FRCP, FESC, FACC, MBBS, DA, BSc

Consultant Cardiologist

Dr Diana Holdright
 
 

Treatments - TAVI

With the ageing of the general population in Western society we are seeing an ever increasing number of older patients, typically in their 70s, 80s or more, with wear and tear of the main heart valve, the aortic valve. This frequently manifests as a progressive narrowing of the valve which, if left untreated, would ultimately cause symptoms and a fatal outcome. Surgery to replace the aortic valve remains the gold standard treatment, but many elderly patients are frail and have other medical conditions, making conventional surgery a high risk strategy. In recent years a novel, percutaneous and minimally invasive technique to treat aortic valve disease has been pioneered, and uptake of the technique is developing rapidly; this is called transcatheter aortic valve implantation (TAVI) and was first performed in man in 2002. There are currently two types of percutaneous aortic valve prosthesis, the balloon expandable Edwards SAPIEN valve and the self-expanding CoreValve.

Although minimally invasive, the procedure remains highly complex and involves a multidisciplinary “TAVI team”, which includes cardiologists, cardiothoracic surgeons, imaging specialists and an anaesthetist. There are a number of ways the valve can be inserted, typically either from the artery in the groin, the transfemoral approach, or transapically, with a small incision in the front of the chest overlying the heart. The procedure is performed under general anaesthesia in most cases. The valve is positioned through a catheter across the patient’s own narrowed valve using echo and X-ray guidance; when the precise position has been located the valve is deployed, squashing the patient’s narrowed valve out of the way, to be replaced by the artificial heart valve. Although this may sound like a simple procedure, especially since it is less invasive than conventional surgery and avoids large scars down the chest, it is not; it carries important procedural risks and complications, not that dissimilar from surgery. At present the procedure is only offered to patients in the UK who have been assessed as too high a risk for conventional surgery. All patients treated with the TAVI procedure are followed up in a UK database to help us refine the indications and contraindications for such a procedure. 

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Related pages:

News - May 2012 - Excellent results from the less invasive heart valve replacement (TAVI) maintained at 2 years

 

Treatments - TAVITreatments - TAVI