Aortic stenosis and TAVI procedure in 5 Questions

What is aortic stenosis, what symptoms are observed in aortic stenosis, and how is it treated? As age advances, the aortic valve undergoes calcification, leading to stiffness (calcification) of the valve. As the calcification increases, the movement of the valve is restricted, causing stenosis. When the stenosis becomes severe, the blood pumped by the heart cannot reach the body adequately. Patients may experience symptoms such as shortness of breath, chest pain, palpitations, and easy fatigue during walking. Fainting may occur when the stenosis progresses further.

Medical treatment for aortic stenosis is not possible since it is a mechanical problem that obstructs the passage of blood. Therefore, it is necessary to address and eliminate this problem. There are two methods used in the treatment. The first is the replacement of the valve through surgery, and the second is the placement of a biological valve through the transcatheter aortic valve implantation (TAVI) method.

What is the TAVI procedure? TAVI (Transcatheter Aortic Valve Implantation) is a procedure where a biological heart valve is placed inside the calcified and restricted aortic valve through the femoral artery using the transcatheter method.

Who is recommended for the TAVI procedure? TAVI is primarily preferred for individuals over 75 years of age with significant aortic stenosis. For those under 75 with risks associated with valve surgery (such as heart failure, diabetes mellitus, and chronic lung disease, or those who have undergone previous heart surgery), TAVI is recommended.

How is TAVI performed? The TAVI procedure is performed in the angiography room, typically with the patient under sedation (given relaxing medication) and local anesthesia, without connecting the patient to a ventilator. The procedure takes about 50-60 minutes. Using thin wires and tubes (catheters), the heart is reached through the femoral arteries on both sides. A thin wire is passed through the calcified aortic valve, and a biological valve is placed in the aortic position via this wire (Figure). The old valve is attached to the aortic wall, and the newly installed valve begins to function immediately. After ensuring that the valve is working properly through necessary checks, the procedure is completed.

Figure: TAVI procedure. A. Biological valve passed through the aortic valve with a thin wire that has not yet been opened. B. Biological valve opened and positioned in the aortic position.

What is the process after the TAVI procedure? How many days does the patient stay in the hospital? With the advancements in modern medicine, the TAVI procedure can be performed using a small vascular route (approximately a 5-millimeter vascular sheath). The patient can walk within 5-6 hours. There is no surgical incision or stitches. The patient is usually kept in the hospital for one or two days and then discharged.

Prof. Dr. Hüseyin Bozbaş Department of Cardiology, TOBB ETU