Avoid open chest operation for valve disease

When open chest surgery the was only solution for heart attacks, simple angioplasty has replaced it in at least 60% of the cases in in the last 15 to 20 years. .But unfortunately until now no solution was available for valve diseases recently. The common valve problem that we see today is mitral valve and aortic valve. Aortic valve is the major valve which paves way for the pumped blood from the heart to entire body. Aortic valve constriction and stenosis (narrowing) causes dizziness, breathing difficulty. Faints and in extreme cases sudden death (because blood does not reach entire body).But now we have got a good technology just as angioplasty, aortic stenosis can be treated by stent without opening the chest ,but not in all cases.

This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

Valve-within-valve — How does it work?

Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter.

Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating

How is TAVR or TAVI different from the standard valve replacement?

This procedure is fairly new and is FDA approved for people with symptomatic aortic stenosis who are considered an intermediate or high risk patient for standard valve replacement surgery. The differences in the two procedures are significant.

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What is involved in a TAVR procedure?

Usually valve replacement requires an open heart procedure with a “sternotomy.”, in which the chest is surgically separated (open) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place.

A TAVR procedure is not without risks, but it provides beneficial treatment options to people who may not have been candidates for them a few years ago while also providing the added bonus of a faster recovery in most cases. A patient’s experience with a TAVR procedure may be comparable to a balloon treatment or even an angiogram in terms of down time and recovery, and will likely require a shorter hospital stay (average 3-5 days).

The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

  • Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest
    or
  • Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

Who is a good candidate for this type of valve surgery?

At this time the procedure is reserved for those people for whom an open heart procedure poses intermediate risk. For that reason, most people who have this procedure are in their 70s or 80 and often have other medical conditions that make them a better candidate for this type of surgery.with the promising results now researchers are doing this for LOW RISK patients also.

TAVR can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.In coming years this will play a major role and big boon to the patients.

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