Transcatheter Aortic Valve Replacement / Implantation

 

For a given disease related to our body, there are different corrective procedures. These procedures are imparted according to the convenience and preferences. This also holds true for our heart valve. If the normal functioning of our heart valve is disrupted, then there is no way that our body can perform normally. This can be corrected with the help of a valve replacement or implantation. There are different procedures to replace this valve. One of the methods is transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). Dr Amit Kumar Chaurasia of Heart Valve Therapy makes sure that TAVI/TAVR is a smooth process and there are no complications in the procedure.

TAVR or TAVI is a minimally invasive procedure in which the damaged valve is repaired without removing the old valve. This procedure is advised to patients who are considered as high risk for an open heart surgery. This process is imparted when the valve does not open properly. Aortic valve stenosis is commonly solved with the help of TAVR. If not solved, then aortic valve stenosis causes chest pain, fainting, fatigue, leg swelling and shortness of breath. It can also prove to be fatal as heart failure and sudden cardiac death can also happen. With TAVR, the survival rate is also high.

The most important feature of TAVR is that the new devices are implanted without the help of open heart surgery. A catheter is required to deliver a fully collapsible replacement valve. When this new valve expands, old valve is gradually pushed out and the tissues in the replacement valve do the job of regulating blood flow. This is a fairly new procedure and is chosen by patients who do not want to go for a complex open heart surgery. The procedure of TAVR does not require large openings. It can be done with the help of small openings which means that no chest bones are moved from their original place. There are two different approaches with the help of which TAVR can be performed –

1. First is the transfemoral approach in which does not require any incisions. The valve is accessed by entering through the femoral artery which is a large artery in the groin.

2. Second is the transapical approach which is a minimally invasive procedure and small incisions are required. Entrance is made through chest or through the tip of the left ventricle.

Transcatheter Tricuspid Valve Intervention

It is impossible to function normally with a heart that is not working in proper condition. One of the most important components of the heart is the mitral valve. It is that valve which lets the blood flow from one chamber of the heart which is the left atrium to another chamber which is called as left ventricle. There is another valve known as tricuspid valve. Out of all the valves, this is the least treated valve. There are different diseases that come in between the normal functioning of the tricuspid valve. One of them is tricuspid regurgitation which is solved with the help of transcatheter tricuspid valve intervention.

What is a tricuspid valve?
A tricuspid valve is on the right dorsal side of heart. It is located between the right atrium and the right ventricle. The main function of this valve is to prevent back flow of blood into the right atrium. It consists of three leaflets – anterior, posterior and septal, the chordae tendinae, two discrete papillary muscles, the fibrous tricuspid annulus, the right atrial and right ventricular myocardium.

What is transcatheter tricuspid valve repair?
The devices that are used for tricuspid valve repair depends on the size and flexibility of the tricuspid annulus and the surrounding myocardium as well as the loss of anatomic landmarks. This process is successfully applied on the tricuspid valve to achieve circumferential annulus reduction. Although the repairing with this process is technically challenging, it has great potential for treating tricuspid regurgitation.

In this procedure, general anesthesia is provided with interventional guidance from transoesophageal echocardiography and fluoroscopy. This procedure can be performed irrespective of the annulus size and adjacent anatomic structures. No implant is left behind and even a partial correction of tricuspid regurgitation is possible which will also avoid the haemodynamic burden of acute complete correction or tricuspid regurgitation to the right ventricle.

What is transcatheter replacement of the tricuspid valve?
When this procedure takes place, cardio pulmonary bypass is preferable as there may be predictions which are difficult to predict and lead to rapid haemodynamic compromise. The initial experience is via a direct transatrial approach but now transvenous access is well established and preferable. The inflow of the tricuspid valve is from a cranial angle and downward. But this is not acceptable in many patients where the valve is oriented more horizontally and pushing forces a cranial approach which results in the device prolapsing down towards the inferior vena cava and crossing the degenerate bioprosthetic valve may be very problematic.

 


FAQ'S

 

1. Who is a good candidate for TAVR?

You are a good candidate if you are in risk for open heart surgery.

2. Is TAVR safe?

It is considered as relatively safe but there are significant risks too. Heart failure or coronary heart disease can also happen.

3. How long does a TAVR valve last?

According to the data of the last five years, TAVR valve is durable up to 5 years.

4. How long will be the hospital stay?

As the procedure is evolving, the time of stay is getting shorter. You can leave the hospital in few days .

1. Who are the candidates?

This procedure is recommended for patients who are very sick and are considered as high risk patients.

2. What is the main cause to undergo this intervention?

Clinically sever tricuspid regurgitation has been reported in 23-37 percent after mitral valve replacement.

3. Are there any other processes required in addition to this?

Replacement of tricuspid valve disease is rarely done in isolation with the majority of the cases carried out in combination with left heart valve replacement.