In transcatheter aortic valve implantation, the patient is “put to sleep” with general anesthesia. In traditional aortic valve replacement, the patient is placed on a heart-lung machine, also known as cardiopulmonary bypass. The chest wall is then opened, and the patient’s heart can be directly accessed to remove the old valve and implant a new valve. With TAVI, a balloon is used to expand the patient’s own aortic valve to make room for the transcatheter valve. The new transcatheter heart valve is then inserted across the patient’s own aortic valve, and another balloon is used to expand the valve in place. There are two main methods used to place the valve, the transfemoral and transapical approach. The decision to use a particular approach is complex, and best discussed with a physician.
Not all patients are a candidate for transcatheter aortic valve replacement. In general, TAVI is generally used for patients who are considered “too sick” for open heart surgery. Aortic valve replacement through traditional approach is still considered the “gold standard,” with excellent outcomes that have been proven over long periods of follow-up. To determine if you are a candidate for TAVI, you should speak with your cardiologist or contact us to schedule an appointment with one of our surgeons.
recently became one of a select number of sites in the United States to treat patients with the recently FDA-approved . Hoag hospital is the only center in Orange County to offer Transcatheter Aortic Valve Implantation (TAVI). This treatment option provides an important therapy for patients with severe, symptomatic native aortic valve stenosis who are not candidates for traditional surgical replacement.
In patients with severe aortic stenosis, there are multiple techniques that can be used to replace the aortic valve. These include traditional , , and transcatheter aortic valve replacement described here. The decision to perform a specific type of surgery is complex, and involves a complete evaluation of the patient to determine which method will have the best outcome. One advantage of Raney Zusman medical group is that our surgeons are familiar with each of these techniques, and can offer the best option for each patient.
It is critical that the surgeon, cardiologist, or endovascular specialist performing transcatheter aortic valve replacement has the most up to date equipment and a strong supporting team. A hybrid operating room is essential. In the hybrid operating room, a minimally invasive procedure can quickly be converted into a full “open heart” procedure if problems arise. The surgeons of Raney Zusman will be performing the procedure in the recently opened . This state-of-the-art facility has highly sophisticated imaging equipment to facilitate the procedure. Hoag Heart and Vascular Institute also has an established multi-disciplinary team involving cardiac surgeons, interventional cardiologists, cardiac anesthesiologists and perfusion team for potential cardiopulmonary bypass. They work in close contact with support staff, including cardiac nurses and physicians specializing in cardiac intensive care after the procedure has been completed.
Implantation of the Edwards Intuity aortic bioprosthesis is an innovative approach associated with superior hemodynamic performance, significantly reduced myocardial ischaemia and cardiopulmonary bypass times and proves to be suitable for type 1 and 2 of bicuspid aortic valves replacement.
We report a case of successful AVR using a fast deployment bioprosthesis,the Edwards Intuity Valve System, in a 67-year-old woman with a bicuspid aortic valve and concomitant severe aortic stenosis.
A comprehensive list of potential adverse events can be found at the . It is important to note that many of these risks are also seen with traditional open heart replacement of the aortic valve.
There are a large number of risks associated with any invasive procedure. The transcatheter valve is also a relatively new procedure, which carries additional risks. Important risks and precautions to consider with transcatheter aortic valve replacement include:
Comparative, nonrandomized studies of aortic valve replacement with stented and stentless valves suggest that the risk of cardiac death is reduced with stentless valves and the rates of valveârelated complications also appear to be lower.