TAVI represents a major advancement in cardiology. It offers a second life to many patients whose hearts were exhausted by a rigid and stenosed valve. Less effort for the heart, lower risks for the patient, and often… a pleasant surprise in the following days: breathing returns.
When the aortic valve hardens...
With age or due to certain conditions, the aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> — which regulates the flow of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood from the heart to the rest of the body — can become rigid and narrow.
This is often caused by calcium deposits that accumulate on the valve over the years. This phenomenon, called aortic stenosis, prevents the valve from opening properly.
In some cases, the stenosis is related to an abnormal valve present from birth (such as a bicuspid valve) or appears after a previous inflammatory disease, like rheumatic fever.
Whatever the cause, when the valve does not open properly, the heart must work harder to circulate the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood. The result: shortness of breath, chest pain, dizziness, or even loss of consciousness. Without treatment, this condition can become very serious.
Read more: Aortic stenosis
A bit of history: when an idea changes everything
Until the early 2000s, the only option to replace a diseased aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> was open-heart surgery. This operation, although effective, was heavy and often too risky for elderly or fragile patients.
Then came a major turning point in 2002. Dr. Alain Cribier, a French cardiologist, performed the first implantation of an aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> using a catheter, without opening the chest.
This approach is now known as TAVI, short for Transcatheter Aortic ValveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> Implantation.
How does it work?
In practical terms, TAVI allows the implantation of a new valve inside the diseased one by accessing the heart through an artery, often in the groin.
The artificial valve, folded onto a small tube (like a spring), is guided up to the heart. Once in place, it is deployed, completely crushing the diseased underlying valve and immediately taking over its function.
The advantages of TAVI
The main advantage of TAVI is that it replaces a diseased aortic valve without the need for open-heart surgery. The procedure is therefore less traumatic for the body, causes no significant post-operative pain, and is often performed under light sedation with local anesthesia. Recovery is considerably easier.
In most cases, patients can return home the day after the procedure. Positive effects are often felt quickly: breathing improves, daily activities become possible again, and quality of life significantly increases. For many, it feels as if the heart has found new energy.
Staying realistic
That said, it is important to remain clear-headed: TAVI is not a fountain of youth, nor is it a cure for all problems.
Even if the valve now functions normally, overall cardiovascular and physical condition often remains fragile, as aortic stenosis has long limited physical effort. In addition, other health problems may continue to affect mobility or breathing, such as arthritis or lung diseases.
TAVI offers new breath, but it does not replace comprehensive rehabilitation nor does it make other health issues disappear. It is part of a broader care approach, focused on the individual. This person will now need to work towards regaining exercise tolerance.
Who is TAVI for?
In many centers worldwide, TAVI is becoming the preferred method for replacing a narrowed aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >>, particularly in elderly patients. Its effectiveness, safety, and rapid recovery make it an attractive option.
However, access to this procedure can vary depending on the region or country. In some areas, cost or availability considerations may still limit its use to well-defined groups, such as elderly patients or those considered high risk for conventional surgery.
In younger individuals, TAVI still raises important long-term questions. These patients may require one or more additional interventions during their lifetime, and the so-called valve-in-valve approach (implanting a TAVI valve into another) can present technical challenges, especially if the first valve is small in diameter. For these reasons, choosing TAVI in younger cases requires thoughtful consideration by the specialized team.
In all situations, the decision relies on a thorough evaluation by a specialized team, known as the Heart Team, which determines the safest and most appropriate approach for each case.
The role of the Heart Team
The decision to implant a valve using TAVI is not made alone. It results from an evaluation by a specialized multidisciplinary team, called the Heart Team. Their mission is to assess the severity of the stenosis, the patient’s overall condition, and the risks and benefits of TAVI compared to traditional surgery.
This approach aims to personalize treatment according to each patient’s profile, ensuring a collaborative, ethical, and safe decision-making process.
Read more: The Heart Team
The initial step
The decision to intervene often begins in the office of a healthcare professional when a patient presents with increasingly noticeable symptoms related to aortic stenosis. Transthoracic echocardiography (TTE), a key examination for evaluating this condition, helps confirm the diagnosis and assess the severity of the valve narrowing.
Based on these results, the professional starts a discussion with the patient about possible therapeutic options.
In some situations — very advanced age, significant associated illnesses, or if the patient wishes — a conservative approach, without valve replacement, will be respected.
In other cases, the next step is to perform coronary angiography to check the condition of the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, often at the same time as an angiography of the leg, iliac, and femoral vessels. This latter test ensures that the new valve can be introduced via catheter by assessing the quality of these arterial pathways.
The meeting with a member of the Heart Team
On the same day as the investigations in the catheterization lab, or during a separate appointment, a member of the Heart Team — often a specialized cardiologist or a cardiac surgeon — meets the patient.
They present the two valve replacement options, TAVI and conventional surgery, taking into account the medical situation, the expressed preferences, and the angiographic findings.
This is the time to explain the various aspects of the proposed procedures, while giving the patient plenty of space to ask questions. The planned access route for implanting the new valve is often discussed at this point, and the associated risks are addressed openly.
They may also prescribe additional tests to be carried out later (such as a chest and abdominal CT scan or laboratory tests) in order to complete the evaluation.
A decisive meeting
In the following weeks, members of the Heart Team thoroughly review the entire file and determine, as a team, the most appropriate strategy tailored to each person’s condition. The therapeutic decision is shared, either by phone or in person, along with explanations to justify it.
An approximate date for the procedure may be suggested, depending on local wait times and organization. A reference person is also designated, with contact details in case of health deterioration or for any other questions regarding the next steps.
The day of the procedure
As a rule, the stay involves a short hospitalization with discharge home the following day. In some cases, depending on circumstances, the patient may even be able to leave the same day.
The patient must fast from midnight the night before, including abstaining from medications unless otherwise instructed during preadmission.
Upon arrival in the preparation room, they must remove their clothing and put on a hospital gown. A nurse will place one or two intravenous lines to administer fluids or medications during the procedure, if necessary.
Shaving is performed on the wrists and both groins to prepare for the insertion of catheters into the artery selected by the cardiologist.
Consent form
Before proceeding with the implantation of the aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> by TAVI, the patient must sign an informed consent form. This document confirms that the patient has been fully informed of the benefits and risks associated with the procedure.
In general, these risks have already been explained to the patient, and all questions have been answered. At this stage, the physician considers that the benefits of the procedure outweigh the risks. Let’s now review these risks.
The risks
TAVI (Transcatheter Aortic ValveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> Implantation) is generally a safe procedure, but like any intervention, it carries certain risks. Among the possible complications, strokes occur in about 2 to 5% of cases, often due to the formation of clots or emboli. There may also be leaks around the new valve, occurring in 10 to 20% of cases. These leaks are generally minor and do not require additional treatment.
Other complications may include cardiac conduction problems, affecting about 10 to 15% of patients. These issues can lead to arrhythmias that sometimes require the implantation of a pacemaker. Bleeding may also occur, especially at the insertion site, in about 5 to 10% of cases. Although rare, infections can also develop, affecting about 1 to 3% of patients.
Finally, although very uncommon, vessel or heart injuries may occur in 1 to 2% of cases. The overall mortality rate associated with TAVI is estimated between 2 and 5%, a figure that may vary depending on the patient’s general condition and advancements in technique.
These risks are carefully considered by medical teams, who do everything possible to minimize them and ensure appropriate follow-up after the procedure.
Preparation in the procedure room
At the scheduled time, the patient is transported on a stretcher to the procedure room. The environment is similar to an operating room. Doctors, nurses, and technicians wear gowns, masks, and surgical caps.
The room is kept at a cool, even cold, temperature to ensure the proper functioning of radiology equipment. A sheet is placed over the patient to minimize discomfort.
On the anesthetist’s side
The patient’s comfort remains a priority throughout the procedure. The anesthetist present ensures that everything proceeds safely and calmly.
A small needle is inserted in one of the wrists to place a thin catheter, which allows for continuous bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure monitoring during the entire procedure.
Final preparation
When all the equipment is ready, the nurse thoroughly disinfects the groin areas and, in some specific cases, the neck area.
A large sterile drape is then placed over the patient, and the final monitoring devices are set up. From this point on, it is important to remain as still as possible to ensure the procedure goes smoothly.
The procedure begins
Once the medical team is in place, all the necessary access points are set up. The procedure begins with a small injection to administer local anesthesia where needed.
A catheter connected to a temporary pacemaker may also be inserted into a vein and guided to the heart. This device provides support during key moments of the procedure, especially when implanting the new valve.
A few warm sensations
The team then injects contrast material into the aorta, which may cause a brief warm sensation throughout the body. This step provides a precise image of the diseased valve.
Using this image, the doctors can locate the exact spot to pass the guidewire, which will serve as a “railway track” to deliver the new valve to the heart.
Preparing the new valve
Meanwhile, the replacement aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> is prepared in the room. It is carefully compressed onto a catheter so it can be advanced to the heart.
It’s time
The catheter carrying the valve is introduced through the chosen arterial route and carefully guided to the location of the narrowed native valve. Once properly positioned, the team uses imaging to confirm that everything is ready for deployment.
At this crucial moment, the team will use the equipment in place to accelerate the heart rate to very high levels.
This rapid rhythm greatly reduces the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow ejected by the heart, preventing the valve from moving during placement. It also briefly immobilizes the heart, creating ideal conditions to deploy the valve precisely.
During this short phase, some people may feel slight discomfort, such as dizziness or light-headedness. This is a predictable and temporary effect, which quickly resolves once the heart returns to its natural rhythm, now free of the obstruction.
Images with contrast are then used to check the correct positioning and proper functioning of the new valve.
Removing the equipment
All that remains is to remove the catheters used during the procedure and carefully close the vascular access points. The patient is then transferred to the recovery room or their hospital room, where monitoring continues.
If everything goes well, discharge is usually possible the next day after a cardiac ultrasound has confirmed the success of the procedure. If all favorable conditions are met and the general state allows, returning home on the same evening of the procedure may also be considered.
In summary
TAVI represents a major advancement in cardiology. It offers a second life to many patients whose hearts were exhausted by a rigid and stenosed valve.
Less effort for the heart, lower risks for the patient, and often… a pleasant short-term surprise: breathing returns, along with quality of life!
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