33364 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach

Name of the Procedure:

Transcatheter Aortic Valve Replacement (TAVR) / Transcatheter Aortic Valve Implantation (TAVI) with Prosthetic Valve; Open Iliac Artery Approach

Summary

Transcatheter Aortic Valve Replacement (TAVR/TAVI) is a minimally invasive procedure used to replace a diseased aortic valve with a new prosthetic valve. This specific approach involves accessing the heart through an open incision in the iliac artery, located in the lower abdomen or upper thigh.

Purpose

TAVR/TAVI is primarily used to treat severe aortic stenosis, a condition where the aortic valve becomes narrowed, restricting blood flow from the heart to the rest of the body. The goal of the procedure is to improve blood flow, reduce symptoms, and enhance the patient’s quality of life.

Indications

• Severe aortic stenosis with symptoms such as chest pain, fatigue, shortness of breath, and fainting.
• Patients at high risk for traditional open-heart surgery.
• Elderly patients or those with other comorbid conditions that make surgery risky.

Preparation

• Fasting for 8-12 hours prior to the procedure.
• Adjustment or discontinuation of certain medications as directed by the physician.
• Pre-procedure diagnostic tests, including blood tests, electrocardiogram (ECG), echocardiogram, and CT scans to assess the heart and blood vessels.
• Meeting with the anesthesiologist to discuss sedation or anesthesia options.

Procedure Description

1. The patient is given local anesthesia and sedation, or general anesthesia as needed.
2. An incision is made in the iliac artery in the lower abdomen or upper thigh.
3. A catheter is advanced through the iliac artery to the heart.
4. A collapsible prosthetic valve is guided through the catheter to the site of the diseased valve.
5. The new valve is expanded and positioned within the old valve.
6. The catheter is then removed, and the incision is closed.
7. The medical team monitors the heart and blood circulation to ensure proper valve function.

Duration

The procedure typically takes 2-4 hours.

Setting

TAVR/TAVI is performed in a hospital, specifically in a catheterization laboratory or a hybrid operating room.

Personnel

• Interventional cardiologist
• Cardiovascular surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist

Risks and Complications

• Bleeding, especially at the incision site
• Infection
• Blood vessel injury
• Heart attack or stroke
• Valve leakage or movement
• Arrhythmias (irregular heartbeats)
• Kidney damage due to contrast dye

Benefits

• Relief from symptoms such as chest pain, fatigue, and breathlessness.
• Improved heart function and quality of life.
• Shorter recovery time compared to traditional open-heart surgery.
• Lower risk of complications for high-risk surgical patients.

Recovery

• Initial recovery in the hospital for 2-5 days, with close monitoring.
• Pain management with prescribed medications.
• Instructions to avoid strenuous activity for a specified period.
• Follow-up appointments with the cardiologist to monitor heart function and valve performance.
• Gradual return to normal activities over several weeks.

Alternatives

• Surgical Aortic Valve Replacement (SAVR): Traditional open-heart surgery to replace the valve.
• Balloon Valvuloplasty: A temporary measure to widen the narrowed valve.
• Medical management: Medications to manage symptoms but do not correct the valve problem.

Patient Experience

During the procedure, the patient may feel the effects of sedation but should not feel pain. Post-procedure, there may be discomfort at the incision site, managed with pain medication. Patients may experience some fatigue but should gradually feel improvements in symptoms within weeks. Regular follow-up is crucial to ensure the new valve is functioning correctly.