Transapical Aortic Valve Implantation: Unlocking the Lifelines

What Is Transapical Aortic Valve Implantation?

Transapical aortic valve implantation is a minimally invasive surgical intervention to treat aortic valve stenosis (sometimes called transcatheter aortic valve replacement). In contrast to traditional open-heart surgery, transapical aortic valve implantation involves accessing the aortic valve using a small incision made in the chest wall (apex part of the heart). The aortic valve replacement is then guided through blood vessels and implanted with the diseased aortic valve. The transapical aortic valve implantation approach is often used in highly risky or inoperable patients since it helps reduce the necessity of extensive surgery and anesthesia.

What Is Transapical Aortic Valve Implantation Used For?

Transapical aortic valve implantation is typically indicated for people with severe aortic stenosis.

The other specific indications and applications of this procedure include the following.

• Severe Aortic Stenosis: The transapical aortic valve implantation procedure is primarily used for individuals with severe narrowing of the aortic valve called aortic stenosis, which restricts blood circulation from the left ventricle to the rest of the body. The typical symptoms of aortic stenosis include chest pain, heart failure, and shortness of breath.

• Inoperable Cases: Some people might be regarded as inoperable because of severe underlying medical illnesses and frailty. Such cases make transapical aortic valve implantation a suitable choice.

• High Surgical Risks: This procedure is often suggested for people who are deemed high risk for conventional open-heart surgery and other surgical interventions due to determinants like age, multiple comorbid conditions, and other medical problems.

How Is Transapical Aortic Valve Implantation Done?

Transapical aortic valve implantation is a minimally invasive technique to replace the diseased aortic valve with an artificial or prosthetic valve. Here is an overview of how this procedure is generally performed.

• The individual undergoes a comprehensive evaluation, like imaging tests, to evaluate the anatomy of the diseased valve and its surrounding structures before the procedure.

• The transapical aortic valve implantation procedure is usually performed in the operating room under general anesthesia.

• The surgeon then selects the access site for the procedure.

• A small incision is made in the chest wall, proximal to the apex of the heart. Other access areas, like transfemoral (groin) or trans subclavian (collarbone), might be utilized during the procedure.

• Then, a guidewire is inserted within the access site and propelled through the blood vessels toward the aortic valve.

• In certain cases, a balloon catheter can dilate the narrowed aortic valve, enhancing the blood flow temporarily before the implantation of the new valve.

• Then, the bioprosthetic valve made of animal tissue is compressed and laid on a catheter.

• The catheter is then advanced through the access position and placed within the native or actual aortic valve.

• The new prosthetic valve is then extended into the place by means of a self-expanding mechanism or balloon. The new valve then becomes the new functioning aortic valve.

• The function of the implanted valve is then assessed through various tests, including echocardiography, to ensure appropriate position and function.

• The access site is closed once the placement and desirable function are achieved.

What Are the Advantages of Aortic Valve Implantation?

Transapical aortic valve implantation provides several benefits, making it a valuable treatment option for certain people with severe aortic valve stenosis. Several key advantages of the procedure are discussed below.

• Minimally Invasive: Transapical aortic valve implantation is a minimally invasive procedure compared to conventional open-heart surgery. This is because the implantation procedure typically incorporates small incisions in the chest wall and the use of blood vessels in the groin area for access. Moreover, this results in minimal trauma to the individual’s body.

• Lower Surgical Risk: Aortic valve implantation is considered a suitable choice for even patients who are at increased surgical risk and are deemed inoperable for the traditional open-heart surgical intervention because of factors like age and multiple comorbidities.

• Reduced Recovery Period: The people who have undergone transapical aortic valve implantation report that they had shorter hospital stays and rapid recovery time compared to people with open-heart surgery, resulting in a quicker return to routine life.

• Extended Lifespan: Transapical aortic valve implantation expands the lifespan of individuals with severe aortic stenosis by enhancing cardiac function and reducing the risk of heart failure.

• Augmented Quality of Life: Transapical aortic valve implantation could help alleviate the symptoms associated with aortic stenosis, including chest pain, heart failure, and shortness of breath, improving overall quality of life.

• Customized Approach: This implantation procedure can be tailored to the individual’s specific anatomy and condition. So, various multiple access routes like transapical, transemoral, and trans subclavian are available. In addition, a range of types of prosthetic valves are available.

• Minimal Pain and Scarring: The minimally invasive form of transapical aortic valve implantation often paves the way for less pain and scarring, contrary to conventional open-heart surgery.

What Are the Contraindications of Transapical Aortic Valve Implantation?

Transapical aortic valve implantation might not be suitable for every person, and this procedure includes certain contraindications that should be considered.

• Anatomy of Aortic Valve: Significant anatomic issues about the aortic valve and the surrounding structures might preclude the transapical aortic valve implantation procedure. For example, the presence of a severely calcified aortic valve, extensive aortic root disease, or intense aortic regurgitation might limit the use of this procedure.

• Coagulation Problems: Individuals with bleeding disorders and those who are under long-term anticoagulant treatment might have increased risks associated with this procedure.

• Severe Left Ventricular Dysfunction: In some cases, severe dysfunction or impairment of the left ventricle space might make the implantation less effective because the heart might not function adequately following the procedure.

• Improper Vascular Access: Inadequate access through blood vessels, especially iliofemoral arteries, might make the implantation procedure challenging. Hence, people with tiny and severely diseased blood vessels may not be suitable candidates for aortic valve implantation.

• Limited Life-Expectancy: Transapical aortic valve implantation might not be recommended for individuals with a limited life expectancy because of non-cardiac illnesses.

Conclusion

Transapical aortic valve implantation surgery offers a less invasive alternative to traditional surgical techniques for patients with severe aortic stenosis. This procedure is considered a valuable option as it contributes to quicker recovery times and fewer complications compared to conventional surgical interventions like open-heart surgery.