33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach

Name of the Procedure:

Transcatheter Aortic Valve Replacement (TAVR/TAVI) with Prosthetic Valve; Percutaneous Femoral Artery Approach

Summary

Transcatheter Aortic Valve Replacement (TAVR or TAVI) is a minimally invasive procedure used to replace a diseased aortic valve. By inserting a new prosthetic valve via a catheter through the femoral artery in the leg, this method avoids the need for open-heart surgery.

Purpose

TAVR addresses severe aortic stenosis, a condition where the heart's aortic valve narrows, obstructing blood flow. The goal is to improve blood flow, alleviate symptoms like shortness of breath and chest pain, and enhance overall quality of life and survival rates.

Indications

• Severe symptomatic aortic stenosis
• Patients at intermediate or high risk for traditional open-heart surgery
• Specific criteria as assessed by a heart team, including cardiac surgeons and interventional cardiologists

Preparation

• Patients may be instructed to fast for 8-12 hours prior to the procedure.
• Medication adjustments, such as stopping blood thinners.
• Pre-procedure tests include echocardiogram, electrocardiogram (ECG), CT scan, and blood tests.

Procedure Description

1. Anesthesia: General anesthesia or conscious sedation is administered.
2. Access: A small incision is made in the groin to access the femoral artery.
3. Catheter Insertion: A catheter is threaded through the femoral artery to the heart's aortic valve.
4. Valve Deployment: A balloon-expandable or self-expanding prosthetic valve is positioned inside the diseased valve.
5. Verification: Imaging techniques ensure the new valve is working properly.
6. Closure: The catheter is withdrawn, and the incision site is closed.

Duration

The procedure typically takes 1-2 hours.

Setting

TAVR is performed in a hospital's catheterization lab or hybrid operating room equipped with advanced imaging technology.

Personnel

• Interventional cardiologist
• Cardiothoracic surgeon
• Anesthesiologist
• Specialized nurses and technicians

Risks and Complications

• Stroke
• Vascular complications
• Bleeding
• Valve malposition or dysfunction
• Heart attack
• Rarely, death

Benefits

• Improved heart function
• Symptom relief (e.g., reduced shortness of breath, chest pain)
• Enhanced quality of life
• Shorter recovery time compared to open-heart surgery

Recovery

• Typically involves a hospital stay of 2-5 days.
• Patients may begin walking and resuming light activities shortly after.
• Follow-up includes regular check-ups, echocardiograms, and medication management.

Alternatives

• Surgical aortic valve replacement (SAVR): Open-heart surgery with a longer recovery time.
• Medical management: Medications to manage symptoms, which does not address the valve obstruction.
• Balloon aortic valvuloplasty: Temporary relief through a balloon to widen the valve.

Patient Experience

• Minimal pain during the procedure due to anesthesia.
• Post-procedure discomfort at the incision site; managed with pain medication.
• Gradual improvement in symptoms over the first few weeks.
• Regular follow-up appointments to monitor valve function and overall heart health.