Hello and welcome to all! I am very excited to have the opportunity to share what I will be researching over the next few months.
My senior research project is focused on the implications of Transcatheter Aortic Valve Implantation (TAVI) and potential problems that arise from this procedure. As an introduction to my research project I will lay some foundation on he application of TAVI.
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| Figure 1 |
Transcatheter Aortic Valve Replacement (TAVR)--another term for TAVI--is a minimally invasive, FDA approved procedure used to treat patients diagnosed with Aortic Stenosis, a condition where the aortic valve becomes narrowed and or obstructed. The most common form of Aortic Stenosis is degenerative caused by age-related calcium deposits (see figure 2). Occasionally, Aortic Stenosis can be caused by a congenital disorder such as a bicuspid valve (an aortic valve that has two leaflets as opposed to three). Symptoms of this disease include: chest pain, fainting, fatigue, heart palpitations and heart murmurs. Severe Aortic Stenosis is a contributing factor to heart rhythm abnormalities, inadequate blood flood, and heart failure. Without treatment the average life expectancy after the onset of heart failure is between 6 to 24 months.
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| Figure 2 |
TAVR is considered the ideal treatment option for patients who are considered high risk for standard surgical valve replacement surgery. This reasoning is simply based on TAVR's non-invasive nature. For this reason, most people who have this procedure are in their 70s or 80s and often have other medical conditions that make them a good candidate for this surgery. Once diagnosed, a cardiologist or surgeon must then assess which appropriate approach to TAVR's application.
This procedure can be pro formed using a few different strategies. A physician can enter through the femoral artery (a large artery in the groin region) and access the heart by navigating up through the body's arterial system. This is called the transfemoral approach, which does not require a surgical incision in the chest. The second requires a minimally invasive surgical approach with a small incision in the chest and entering through the tip of the left ventricle or the apex of the heart. This is known as the transapical approach. For a visual, see figure 3.
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| Figure 3 |
A TAVI procedure does not come without risk. However, TAVI provides a treatment option for patients who previously where deemed too high of a risk to surgically operate on. TAVI also provides the added benefits of a shorter recovery time with an average hospital stay of 3-5 days. Transcatheter Aortic Valve Repair is an emerging treatment option that is improving every year. It provides a multitude of benefits as its application advances. But regardless, it is up to the medical community to decide whether this procedure's application is more beneficial than its competitors. Truthfully, only time will tell.
Thank you for taking the time to read through one of my posts. Please comment if you have any questions or just want to be heard. I look forward to responding.
Hi I'm Val and I attend BASIS Scottsdale! I just had a few questions. First, does the TAVI completely replace the old valve? And second, what is the life expectancy of patients after this treatment? Are they at risk for having to undergo another TAVI procedure?
ReplyDeleteHi Val! Thank you for the questions! To answer your first question, yes and no. The original valve is still there, it is just held open by the TAVI device. What happens is the catheter with a very small balloon is inflated to open the original native leaflets and the new device is put into place. So the TAVI device replaces the functionality of the old valve, but the native leaflets of the original valve are still there. By opting for this treatement a patient can avoid going under intensive surgery for a complete valve "replacement."
DeleteIn regards to your second question, It is difficult to give a specific time frame as it varies on a case by case basis. But clinical studies have found that patient life expectancy had been increased by one to five years. Considering that the patients who typically undergo a TAVI procedure have been already deemed too high of risk for a complete replacement because of their poor condition or frailty, a life extension of several years is considered quite a feat.
To answer your third question, once an individual is implanted with a TAVI device complications can occur. Anything from leaks between the valve and the endocardium (which is what I will deal with mostly in my project) to a poor fitting deployment where the device migrates. When there are leaks in the device, sometimes physicians are able to repair it with a seal. In regards to functionality and positioning problems, some devices are re-captureable and a physician can replace or reposition a device. But this potentially puts a patient under high risk further damage to the aortic valve. Ideally this is a one time, one shot procedure.
Thanks again for the question! If you have any more, please ask!
Hi Chance,
ReplyDeleteWhat percentage of the population would this procedure address?
Thank you for your question Mrs. Hartwoman! Aortic stenosis affects approximately 5 out of every 10,000 people in the United States. Worldwide, approximately 300,000 people have been diagnosed with severe aortic stenosis, and approximately one-third of these patients are deemed at too high a risk for open-heart surgery. It would be this percentage of the population that is considered for a TAVI procedure. Additionally, AS is more likely to affect men than women; 80 percent of adults with symptomatic AS are male.
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