Transcatheter Aortic Valve Replacement - Procedure and Risks

Introduction

Transcatheter aortic valve replacement is an invasive procedure that replaces the heart's aortic valve when it fails to function properly due to the narrowing of the vessel. Aortic valve stenosis is a common issue that leads to the narrowing of the aorta. The aorta is the largest and strongest blood vessel present in the heart that functions to pump blood out of the heart to the rest of the body. Transcatheter aortic valve replacement is invasive but not to an extent.

Also, TAVR or transcatheter aortic valve replacement is not known to be a complicated procedure. During the procedure, a new valve replaces the damaged valve via a catheter. It is slightly similar to stent placement. After the new valve is placed and expanded, the defective leaflets of the old valve are pushed out. The new valve begins working as soon as it is lodged in position, and the entire procedure is completed within two hours. General anesthesia or local anesthesia is the decision of the healthcare provider, depending on the patient’s present condition.

What Causes Aortic Valve Disease?

The heart has four chambers- two upper sections, the right and left atrium, and two lower sections, the right and left ventricles. Parallel to four chambers, the heart has four valves: mitral, tricuspid, aortic, and pulmonary.

Valves are a crucial part of the heart’s structure. They open and close as the blood passes through them. They mainly regulate the entry and exit of blood into the heart’s various chambers. The valves have flaps or leaflets that open and close. Valves with three leaflets open and close simultaneously. To avoid any sort of backflow of blood, the leaflets close, and visa versa is why they open.

The mitral or bicuspid valve allows blood to flow smoothly from the left ventricle into the left. It has two leaflets. The tricuspid valve allows blood to flow easily from the right atrium into the right ventricle. It has three leaflets. The aortic valve controls smooth blood flow from the left ventricle to the aorta. The pulmonary valve primarily allows smooth blood flow from the right ventricle into the pulmonary artery. It has three leaflets. Aortic valve disease develops due to various underlying factors that may not have been diagnosed and treated on time. There are many reasons for aortic valve disease, ranging from congenital disabilities to age-related changes.

Mentioned below are some of the causes of aortic valve disease.

• Rheumatic heart disease.

• Endocarditis is an infection of the lining present within the heart.

• Intravenous drug.

• Untreated, long-standing infection of the heart.

• Degenerative changes.

• Infection of the blood.

• Congenital heart valve disease.

• Myocardial infarction.

• Heart failure.

• Atherosclerosis.

• Thoracic aortic aneurysm.

• High blood pressure.

• Lupus.

• Marfan syndrome.

• Exposure to high doses.

• Autoimmune conditions.

• Age.

• Valve ring dilatation.

• Syphilis aortitis.

• Traumatic valve rupture.

• Trauma to the papillary muscle.

How Are Diseases of the Aortic Valve Diagnosed?

Aortic valve disease may be diagnosed during a regular consultation with a physician after a few extra diagnostic tests. A stethoscope can pick up any abnormal heart murmurs and regurgitation sounds. To confirm the presence of valvular regurgitation or valvular stenosis, additional tests such as those mentioned below may be suggested. Physical examination and a detailed account of medical as well as drug history are vital for the diagnosis of aortic valve disease.

• Electrocardiography.

• Ultrasound of the heart.

• Complete blood picture.

• Doppler echocardiography.

• X-ray of the chest.

• Transesophageal echocardiogram.

• Magnetic resonance imaging of the heart.

• Catheterization.

What Are the Steps During Transcatheter Aortic Valve Replacement?

A transcatheter aortic valve replacement takes place in a hospital setup. Mentioned below are the steps that occur during a transcatheter aortic valve replacement.

• Intravenous anesthesia is administered.

• Blood pressure and breathing patterns will be continuously monitored.

• A TEE or transesophageal echocardiogram is placed into the esophagus. This helps to monitor the functions of the valves.

• A catheter is inserted via the groin, the neck, or beside the chest.

• The diseased valve is removed from the heart, and an artificial valve is replaced.

• Once the surgery is complete, the heart receives a shock that helps it to start beating again.

• The heart valve is examined for its functions and strength and to make sure there are no leakages.

• For an initial recovery, pacemakers may be introduced for a short span.

• The fluid and blood accumulated around the surgical sight are drained.

• A bandage with surgical dressing is placed.

What Outcomes Can an Individual Anticipate From Transcatheter Aortic Valve Replacement (TAVR)?

Transcatheter Aortic Valve Replacement (TAVR) can lead to improved symptoms, enhanced quality of life, and a lower risk of mortality in individuals with aortic valve issues. However, outcomes may vary, and it's essential to discuss specific expectations with a healthcare professional based on individual health conditions.

What Are the Non-surgical Methods for Addressing a Leaky Heart Valve?

Managing a leaky heart valve without surgery typically involves medical management and lifestyle modifications. However, it's crucial to note that the effective outcome of non-surgical approaches can vary depending on the condition’s severity. Consulting a healthcare professional for personalized advice may be beneficial. Some non-surgical methods for managing a leaky heart valve include:

Medications:

• Diuretics: Help reduce fluid buildup and relieve symptoms.

• ACE inhibitors or ARBs: Manage blood pressure and reduce strain on the heart.

• Beta-blockers: Control heart rate and reduce the workload on the heart.

Lifestyle Changes:

• Exercise: Regular, moderate exercise can improve overall cardiovascular health, but specific recommendations should be discussed with a healthcare provider.

Regular Monitoring:

Regular check-ups with a cardiologist are important to monitor the disease progression and adjust treatment.

Close Observation:

For mild cases, close observation without immediate intervention might be recommended.

Conclusion

Transcatheter aortic valve replacement is minimally invasive as compared to open-heart surgery. This procedure is done to correct or replace the defective aortic valve. The procedure is over within two hours, and the patient is given a thorough understanding of what to do and what not to do after the replacement. Not everyone is eligible for TAVR or transcatheter aortic valve replacement, and only the healthcare provider will decide to go ahead with transcatheter aortic valve replacement for a patient by bearing several factors in mind. The outlook is generally positive for patients who have successfully undergone transcatheter aortic valve replacement