Name of the Procedure:

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

Summary

Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive procedure used to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). The open axillary artery approach involves accessing the heart through an incision in the axillary artery, which is located in the armpit.

Purpose

TAVR is used to treat aortic valve stenosis, which can cause severe heart problems, including heart failure. The goal is to replace the faulty valve with a prosthetic one, thereby improving blood flow and reducing symptoms such as chest pain, shortness of breath, and fatigue.

Indications

• Severe aortic valve stenosis causing symptoms like breathlessness, chest pain, or fainting.
• Patients who are at high or intermediate risk for complications from conventional open-heart surgery.
• Elderly patients or those with other health conditions making traditional surgery too risky.

Preparation

• Patients may be required to fast (no food or drink) for several hours before the procedure.
• Medications (such as blood thinners) may need to be adjusted.
• Pre-procedure tests include imaging studies like echocardiograms, CT scans, and cardiac catheterizations to assess the severity of the valve stenosis and plan the procedure.

Procedure Description

1. The patient is placed under general anesthesia to ensure they are asleep and pain-free.
2. A small incision is made in the armpit to access the axillary artery.
3. A catheter is inserted into the artery and guided to the heart.
4. Through this catheter, a compressed prosthetic valve is advanced to the site of the aortic valve.
5. The new valve is expanded, pushing the old valve out of the way and taking over its function.
6. The catheter is removed, and the incision is closed.

Tools used include catheters, balloon-expandable or self-expanding prosthetic valves, and imaging equipment for precise placement.

Duration

The procedure typically takes about 1-2 hours.

Setting

TAVR with the open axillary artery approach is performed in a hospital, usually in a specialized cardiac catheterization lab or hybrid operating room.

Personnel

• Interventional cardiologists or cardiothoracic surgeons
• Anesthesiologists
• Cardiac nurses and technicians
• Imaging specialists

Risks and Complications

• Bleeding or infection at the incision site
• Blood vessel damage
• Stroke
• Heart attack
• Kidney complications
• Prosthetic valve malfunction
• Arrhythmias

Benefits

• Relief from symptoms associated with aortic stenosis
• Improved quality of life
• Lower risk compared to traditional open-heart surgery, especially in high-risk patients
• Faster recovery times

Recovery

• Patients may need to stay in the hospital for 2-5 days after the procedure.
• Follow-up includes regular check-ups and imaging tests to assess the function of the new valve.
• Activity restrictions and guidance on gradual increase in physical activity.
• Medications like blood thinners to prevent clots.

Alternatives

• Surgical Aortic Valve Replacement (SAVR): Conventional open-heart surgery, which may be recommended for younger, healthier patients.
• Balloon Aortic Valvuloplasty (BAV): A temporary measure that can relieve symptoms but does not replace the valve.
• Medical management: Medications to manage symptoms but do not treat the underlying valve problem.

Patient Experience

• During the procedure, the patient will be asleep under general anesthesia.
• Post-procedure, patients may experience some discomfort at the incision site and general fatigue.
• Pain will be managed with medications, and comfort measures include guidance on sleeping positions and activity modifications.
• Most patients experience a significant improvement in symptoms within a few days to weeks.