Latest Treatments for Aortic Stenosis, including:
Transcatheter Aortic Valve Implantation (TAVI), Balloon Aortic Valvuplasty (BAV) and Drugs
#TAVI - different approaches
#The advantages of TAVI
#The Disadvantages of TAVI
#Balloon Aortic Valvuplasty (BAV)
- #Drug Therapy for Aortic Stenosis
The various options for TAVI and approaches are as follows:
- Transfemoral Approach
- Subclavian Approach
- Direct Aortic Approach
- Transapical Approach
- In TAVI a new aortic valve is implanted in your heart via a tube or catheter. This tube is normally introduced through the artery at the top of your leg (transfemoral approach) and then advanced up to the heart through the blood vessels.
- If these blood vessels are narrowed or diseased then the catheter can be introduced via the blood vessel under your collar bone (subclavian approach) or directly into the aorta by making a small incision in your chest wall (direct aortic approach).
- The final option is to introduce the catheter directly into the heart from the left side of the chest. This is known as a transapical approach.
While the transfemoral approach can be performed without the need for surgery the other approaches require progressively more surgical intervention although they all avoid the need for cardiopulmonary bypass or fully opening the chest cavity.
No need for Surgery with TAVI
With advances in the technology we have found that the majority of patients can be treated by the transfemoral approach without the need for any surgery. Once the catheter has been introduced into the body a guide-wire is fed across the narrowed valve and the valve is stretched open as an initial step. The new valve is mounted within in a metal frame that can be fed through the catheter and positioned inside your own narrowed valve. Depending on the type of valve your doctor chooses, it is then deployed by either using a balloon to expand it or a spring like frame that expands itself when it is released from the catheter.
In both cases your heart continues to beat and pump blood throughout the procedure. Once the valve has been deployed the catheter and guide-wires are withdrawn and the arterial puncture repaired.
The main advantage of TAVI is that it avoids the need for open heart surgery and cardiopulmonary bypass. This means a more rapid recovery and return to normal activities. Patients on average stay in hospital for about 5 days. To date more than 40,000 TAVI procedures have been performed worldwide with overall excellent results compared to surgery and, so far, excellent valve durability.
The main disadvantage of TAVI is that it is relatively new technology and therefore it is difficult to know for sure how long the valves will last. With some valves leakage may occur around the outside of the new valve and in a small number of patients this can be significant and require either a second TAVI procedure or even open surgery. The risk of stroke following TAVI may be higher than following open heart surgery. Other complications include the need for a permanent pacemaker, and the possibility of heart attack or damage to the blood vessel during introduction of the catheter. Fortunately, major complications are now rare and further improvements in the technology should reduce some of the risks further.
In this treatment the narrowed valve is stretched open by a balloon, but no new valve is implanted. It is usually part of the TAVI procedure but occasionally can be used as a treatment in its own right. BAV can be performed through a smaller catheter than TAVI and this is its main advantage. In younger patients with congenital aortic stenosis the BAV can relieve the narrowing for several years but in many patients its effect is short lived and repeat treatment is necessary.
This means either doing nothing or treating the symptoms with medication. As such it is reserved only for those patients who have mild aortic stenosis and no symptoms or patients who are too high risk for other interventions described above. Medication itself cannot treat the narrowed valve but it can make patients feel less symptomatic