Aortic stenosis and the TAVI procedure
Aortic stenosis - or narrowing of the aortic valve - restricts blood flow from the heart to the rest of the body and can lead to serious complications, including heart failure, if left untreated. One of the most advanced treatment options for severe cases is transcatheter aortic valve implantation (TAVI).
What causes aortic stenosis?
Aortic stenosis is primarily caused by:
- Age-related calcification – The most common cause, where calcium deposits stiffen the valve over time.
- Congenital heart defects – Some individuals are born with an abnormal aortic valve, such as a valve with two leaflets instead of three, and these valves may narrow prematurely over time.
- Rheumatic heart disease – A complication of rheumatic fever that can cause scarring and narrowing of the valve.
- Radiation therapy – Previous chest radiation for cancer treatment may contribute to valve damage.
What are the symptoms of aortic stenosis?
Many patients may not experience symptoms until the condition becomes severe. Symptoms can include:
- Chest pain or discomfort
- Shortness of breath, especially with activity
- Fatigue and weakness
- Dizziness or fainting (syncope)
- Heart palpitations
How is aortic stenosis diagnosed?
Aortic stenosis is typically diagnosed through:
- Echocardiogram – The primary test, using ultrasound to assess valve function and severity.
- Electrocardiogram (ECG) – Detects heart enlargement and abnormal rhythms.
- Chest X-ray – Identifies heart enlargement or calcium deposits.
- Cardiac CT or MRI scan – Provides detailed imaging of the heart and aortic valve.
- Cardiac catheterisation – Measures pressures in the heart and evaluates blood flow.
What is TAVI and how does it work?
TAVI (transcatheter aortic valve implantation), also known as TAVR (transcatheter aortic valve replacement), is a minimally invasive procedure used to replace a narrowed aortic valve in patients who are at high or moderate risk for open-heart surgery.
During TAVI:
- A small catheter is inserted into a blood vessel, typically in the groin.
- The new valve is placed inside the narrowed aortic valve.
- Once expanded, the new valve pushes the old valve’s leaflets aside, restoring normal blood flow.
Who is suitable for TAVI?
TAVI is generally recommended for:
- Patients with severe aortic stenosis who are not suitable for open-heart surgery.
- Elderly patients or those with multiple health conditions that make surgery high risk.
- Patients who have had previous heart surgery and require a less invasive approach.
What are the benefits and risks of TAVI?
Benefits:
- Minimally invasive, reducing recovery time compared to open-heart surgery.
- Lower risk of complications in high-risk patients.
- Shorter hospital stay and faster return to daily activities.
Risks:
- Possible bleeding or vascular complications at the catheter insertion site.
- Risk of stroke or transient ischaemic attack (TIA).
- Potential need for a pacemaker if the new valve affects the heart’s electrical system.
- Valve leakage or failure over time, though modern valves are highly durable.
How long is the recovery after TAVI?
Recovery time varies, but most patients:
- Stay in hospital for two to three days post-procedure.
- Experience significant symptom relief within a few days.
- Can resume light activities within a week, and normal activities in a few weeks.
- Require regular follow-up to monitor heart function and valve performance.
TAVI has revolutionised the treatment of severe aortic stenosis, offering a life-extending option for patients who may not be candidates for traditional surgery. Those experiencing symptoms of aortic stenosis should consult a specialist to determine the best treatment approach.