The aortic valve is the heart valve located between the left ventricle (left ventricle), which pumps blood to the body, and the main artery (aorta) that separates from the heart. As people get older, the narrowing of this valve due to deterioration of its structure and calcification is called aortic stenosis. Aortic valve stenosis may develop at an earlier age due to rheumatic fever in childhood or due to congenital structural defects of the valve. The diagnosis of this disease is often made by Echocardiography (heart ultrasonography). If a one-third narrowing occurs in the valve area (valve area is <1 cm2), patients may experience complaints such as chest pain, fainting and shortness of breath, as the amount of blood thrown into the main artery decreases significantly. These patients may also die unexpectedly in the form of sudden cardiac death.
The method called Transcatheter Aortic Valve Replacement (TAVI) is the insertion of an aortic valve into the heart using a catheter (entered from the groin or rarely from the arm) without open heart surgery. process. The heart valves installed during this procedure are biological heart valves obtained from animals (cows, pigs) and are still used in valve replacement surgeries all over the world and in our country. In the TAVI method, this biological valve is placed in a stent sheath and when the stent is opened, the valve is tightly held to the inserted area and placed. The TAVI method is primarily recommended for patients who are too high-risk to tolerate open surgery for valve implantation. Apart from this, this method can also be applied to patients who have any disability for open surgery. In this regard, especially patients who are very old, have lung, liver or kidney dysfunction, or patients who have previously undergone other open heart surgery (bypass, other valve surgery) are considered to be at high risk for open surgery. It is known that the TAVI method is effective in extending life expectancy and improving the clinical condition of these patients for whom open surgery is not suitable. Another thing to know is; This method can be applied to patients with severe aortic stenosis (degenerative aortic stenosis) caused by deterioration and calcification of the valve structure due to aging. . Although initially it could not be performed on valves called congenital bicuspid aortic valves, this technique can now be applied on bicuspid aortic valves. Although it was initially performed only in aortic stenosis, it is possible to perform TAVI only in patients with aortic insufficiency with newly developed valves. However, only patients with aortic insufficiency are fitted with a special valve with different parachute-like legs.
First of all, before TAVI, transesophageal echocardiography (heart ultrasound through the esophagus), cardiac and vascular angiography and multi-slice computed tomography must be performed to understand whether TAVI can be performed. Then, after the TAVI decision is made in the council with the heart team (cardiology, cardiovascular surgery, anesthesia), the TAVI procedure is started. Usually, the artery passing through the groin area is entered with a needle, sometimes by surgically opening the vein in the arm. With a special technique, a plastic pipe system is placed where the needle enters, which will remain throughout the procedure and will be removed at the end of the procedure, through which the cap can be advanced. This tubing system is usually placed routinely by suturing the vein with a closed system, and sometimes by surgeons opening the vein with open surgery. Which method will be required is determined according to the examinations performed before the procedure (tomography and angiography) and the variables during the procedure. A similar plastic tubing system is placed into the vein through the skin without any surgery. The cable of the temporary battery system is sent to the heart through this system. Then, a long guide wire cap is passed through the plastic tubing system placed in the artery and passed into the heart. Then, a balloon is inflated in the aortic valve to provide sufficient opening in the valve by accelerating the heart using a temporary pacemaker. After the balloon is removed, the pacemaker is stimulated again and simultaneously, this time, an artificial heart valve is placed in the expanded area with a special technique. At the end of the procedure, the guide wire is removed. The plastic tube system placed in the groin is removed after a while and the attempted area is closed with stitches. Patients can be kept in coronary intensive care for 1-3 days after the TAVI procedure. While in the hospital and for at least 3 months after discharge from the hospital Patients must be given blood thinners throughout the treatment period. In patients with rhythm disorders, it may be necessary to give additional blood thinners.
If you decide to have this procedure done later, you can come to our cardiology clinic and make an appointment and have the procedure done on the given date.
TAVI procedure is performed on patients whose open heart surgery is considered to be at high risk, according to current information. Previously, only widening of the narrowed aortic valve with the help of a balloon was performed for these patients. However, as a result of the evaluations, it was observed that this method only provided a short-term improvement and after a certain period of time, narrowing of the heart valve occurred again. Therefore, when evaluated in the light of current medical knowledge, there is no alternative treatment for this procedure.
The lifestyle changes you need to make after TAVI will be explained by your doctor when you are discharged. These generally include avoiding fatty foods, physical exercise, weight control and quitting smoking.
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