Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach
CPT4 code
Name of the Procedure:
Transcatheter Aortic Valve Replacement (TAVR/TAVI) with Prosthetic Valve; Open Femoral Artery Approach
Summary
Transcatheter Aortic Valve Replacement (TAVR or TAVI) is a minimally invasive procedure used to replace a narrowed aortic valve that fails to open properly (aortic stenosis). In the open femoral artery approach, the artificial valve is inserted through the femoral artery and guided to the heart without the need for open-heart surgery.
Purpose
Condition Addressed: Aortic stenosis, characterized by the narrowing of the aortic valve opening, restricting blood flow from the heart to the body.
Goals:
- Improve blood flow and reduce symptoms such as chest pain, shortness of breath, and fatigue.
- Enhance quality of life and increase the lifespan of patients with severe aortic stenosis.
Indications
- Severe symptomatic aortic stenosis.
- Patients at high or prohibitive risk for open-heart surgery.
- Ineffectiveness of medical management for the condition.
Preparation
- Fasting: Refrain from eating or drinking for at least 8 hours before the procedure.
- Medication Adjustments: Specific instructions on taking or discontinuing medications.
- Diagnostic Tests: Echocardiogram, cardiac catheterization, CT scan, and blood tests.
Procedure Description
- The patient is given general anesthesia or conscious sedation.
- A small incision is made in the groin to access the femoral artery.
- A catheter carrying the prosthetic valve is inserted into the femoral artery and guided through the blood vessels to the heart.
- The new valve is placed inside the diseased aortic valve, expanding it to push the old valve leaflets out of the way.
- The catheter is removed, and the incision is closed.
Tools and Technology:
- Catheter
- Prosthetic heart valve
- Imaging equipment (fluoroscopy and echocardiography)
Duration
Typically lasts 1 to 2 hours.
Setting
Performed in a hospital's cardiac catheterization lab or specialized surgical center.
Personnel
- Interventional cardiologist or cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Radiologic technologists
Risks and Complications
- Bleeding at the catheter insertion site
- Valve malfunction or misplacement
- Stroke
- Heart attack
- Infection
- Vascular complications
Benefits
- Relief of symptoms related to aortic stenosis.
- Improved cardiac function.
- Quick recovery and shorter hospital stay compared to open-heart surgery.
Recovery
- Post-Procedure Care: Monitoring in the intensive care unit (ICU) for 1-2 days.
- Instructions: Limited physical activity, adhering to prescribed medications, and follow-up appointments.
- Expected Recovery Time: Generally, 1-2 weeks for most patients.
Alternatives
- Medical management with medications (limited effectiveness).
- Surgical aortic valve replacement (involves open-heart surgery).
- Balloon aortic valvuloplasty (temporary relief).
Pros and Cons:
- TAVR is less invasive and has a quicker recovery compared to surgical replacement.
- Surgical replacement may be more suitable for younger patients with lower surgical risks.
Patient Experience
- During the Procedure: Minimal discomfort due to anesthesia or conscious sedation.
- After the Procedure: Possible groin discomfort and bruising, managed with pain medications.
- Comfort Measures: Pain management through medications and support from healthcare staff.
Most patients experience significant symptom relief and improved quality of life post-recovery.