Listed below is the step by step procedure of TAVI surgery:
- What is TAVI Surgery?
- Why is TAVI Surgery Required?
- Pre-operative Preparation
- Day Before Surgery
- Procedure Day
- Methods/Techniques of TAVI Surgery
- Post Procedure
- Risks and Complications
What is TAVI Surgery?
Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve Implantation (TAVI) are the names used interchangeably for denoting surgery for valve replacement. This is done in patients who are not eligible for normal valve replacement surgeries that are done using the traditional open heart technique.
Why is TAVI Surgery Required?
Patients suffering from aortic valve stenosis or aortic stenosis have an improperly functioning aortic valve. People suffering from aortic stenosis find it difficult to execute simplest of routine activities like walking or climbing stairs without panting. For such patients, valve replacement is an option.
Valve replacement is done to repair a damaged valve by fitting an artificial one onto it. If a cardiac surgeon deems fit that you are not fit for open-heart surgery and also when medicines are not helping you feel any better, the TAVI/TAVR procedure may be an alternative.
The tests that are to be done before the actual day of valve replacement are few like electrocardiogram, blood tests, physical assessment and anesthetic evaluation. The patient needs to be physically fit and in a good health condition to be operated. A CT-scan is also ordered for the patient as that helps the doctor to know the size and make of the artificial valve that will be required. Blood vessels also can be assessed through a CT scan and whether the vessels will be able to tolerate the placement of an artificial valve.
Day Before Surgery
- Fasting: You need to be on an empty stomach at least 6 hours prior to the surgery.
- Medicines: You need to ask your doctor as to which medications you need to stop till the surgery gets over.
On the day of procedure, following things happen before you are taken into the operation theater for TAVI Surgery:
- Hospital outfit: Before the procedure starts, you will have to change into a hospital gown.
- Consent form: You will also be made to sign a consent form.
- Fluid intake: On the day of surgery, fluid intake such as tea, coffee, drinks are to be avoided.
- Sterile drapes: Once asleep after receiving anesthesia, sterile sheets are used to cover the patient and also the bed to erase any chances of infections.
Methods/Techniques of TAVI Surgery
The patient is administered general anesthesia for making him fall asleep during the TAVR procedure. An intravenous line is connected to the patient's arm for injecting medications to avert blood clots forming during procedure.
During the treatment, the doctor will keep a tab on your heart rate and heartbeat patterns. Changes in the same can be managed with treatment or medication during surgery itself.
In a TAVR, heart is accessed either through a large artery by way of incision made in your chest or via a blood vessel in your leg. Subsequently, a catheter is inserted through the access point. Imaging techniques are used by the doctor to see how the catheter passes through your blood vessels, to your heart and into your aortic valve.
Once it's positioned as expected, a balloon is inserted for properly super-imposing the replacement valve into the intended place in the original aortic valve. When your doctor is certain the valve is securely in place, the catheter is withdrawn from your blood vessel or from the incision in your chest.
- You maybe shifted to the intensive care unit (ICU) for recovering till the final discharge from hospital is given.
- The doctor may prescribe blood-thinning medications for preventing formation of blood clots in your legs in days post procedure. Remaining active may not prevent, but may limit clots.
Do's and Don'ts Post TAVI Surgery
- For at least 6 weeks following surgery, you need to avoid lifting heavy material, shopping bags and all activities that would put pressure on your chest.
- Also, avoid swimming, cycling and driving in the few weeks post surgery.
- Stress more on walking around and keeping your legs active.
- It is not uncommon for people to lose their appetite post surgery. Try eating small meals so that you do not feel fatigued.
- Many patients, after undergoing this surgery, lose their sense of focus and concentration. It is completely normal.
- Also, swelling in legs in the weeks post surgery is also bound to happen. It is not a cause of major concern.
- If there is bleeding from groin which does not go away on its own, you need to contact the doctor immediately
Risks And Complications
The TAVI surgery is a comparatively safe procedure and a minimally invasive one. However, it does carry few risks with itself. Few of them are as listed below:
- Stroke: The catheter while passing through blood vessels can damage plaque deposits blocking the blood flow in the process and thus setting the stage for stroke like condition. The risk of patient suffering from stroke in later period post surgery is hardly 3-5%. Yet, it is one of the most feared complications a TAVI surgery carries.
- Death: The risk of death again is a very rare possibility as this surgery is a proven life-saving cardiac procedure.
- Kidney failure: There are chances of kidney failure in event of person undergoing TAVI surgery. However, this happens only if there is repeated exposure to contrast agent in previous surgeries or when there is a pre-existing kidney disorder in the person.
- Blood vessel damage: During a TAVI procedure, the blood vessels in the legs are used as access point. Arterial damage and subsequent bleeding are 2 possible complications.
- Aortic regurgitation: The TAVI surgery entails placement of artificial valve in the heart. That may cause aortic regurgitation. In event of aortic regurgitation, blood leaks into left ventricle and since the body does not get uniform blood, pressure builds up on heart.
- What are the benefits of TAVI Surgery?
A. Benefits of the TAVI surgery include a shorter surgery time, less pain, and a shorter stay in the hospital. Recovery time is also significantly shorter than after say an open-heart surgery. The person recovers in about 2-4 weeks. TAVI not only reduces discomfort but also improves life expectancy and quality of life.
- Is there an age limit for performing TAVI surgery?
A. There is no age limit. But the person needs to be absolutely fit to be considered fine for the TAVI surgery. Only then will he/she be given the final nod.
- How long will I have to stay in the hospital post TAVI?
You can be sure to spend at least 7 days in the hospital following the surgery.
- A. When will the follow-up appointment with doctor be?
The follow-up appointment will be scheduled by your doctor exactly after a month from the surgery date.