33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy)

Name of the Procedure:

Transcatheter Aortic Valve Replacement (TAVR/TAVI) with Prosthetic Valve; Transaortic Approach (e.g., Median Sternotomy, Mediastinotomy)

Summary

Transcatheter Aortic Valve Replacement (TAVR/TAVI) is a minimally invasive surgical procedure to replace a diseased aortic valve with a prosthetic valve, typically carried out via a transaortic approach, which may involve accessing the heart through an incision in the sternum (sternotomy) or chest cavity (mediastinotomy).

Purpose

Medical Condition or Problem:

The procedure primarily addresses severe aortic stenosis, where the aortic valve narrows and impedes blood flow from the heart.

Goals/Expected Outcomes:

• Improve blood flow through the heart.
• Alleviate symptoms such as chest pain, shortness of breath, fatigue, and fainting.
• Enhance overall cardiac function and quality of life.

Indications

Specific Symptoms/Conditions:

• Severe symptomatic aortic stenosis.
• Patients who are considered high-risk for traditional open-heart surgery.
• Decreased heart function due to valve narrowing.

Patient Criteria:

• Elderly or frail patients.
• Those with multiple co-morbidities that preclude open-heart surgery.

Preparation

• Patients are typically instructed to fast for several hours before the procedure.
• Medication adjustments may be required, especially anticoagulants.
• Pre-procedure diagnostic tests include echocardiograms, CT scans, and cardiac catheterization.

Procedure Description

1. Anesthesia: Administered general anesthesia or conscious sedation.
2. Incision: A small incision is made in the chest (sternotomy/mediastinotomy).
3. Access: Surgeons gain access to the heart through the aorta.
4. Valve Delivery: A catheter is advanced to the site of the diseased aortic valve.
5. Valve Deployment: The prosthetic valve is placed and expanded within the existing valve.
6. Closure: The incision is closed, and the patient is moved to recovery.

Tools and Equipment:

• Catheters, guidewires, and imaging technology.
• Prosthetic aortic valve.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

Performed in a hospital’s catheterization lab or operating room.

Personnel

• Cardiac surgeons.
• Interventional cardiologists.
• Anesthesiologists.
• Nursing staff and surgical technicians.

Risks and Complications

Common Risks:

• Bleeding.
• Infection.
• Vascular complications.
• Arrhythmias.

Rare Risks:

• Stroke.
• Heart attack.
• Valve malfunction or misplacement.

Management:

Complications are managed with medications, additional procedures, or supportive care as needed.

Benefits

Expected Benefits:

• Relief from symptoms of aortic stenosis.
• Improved heart function.
• Enhanced quality of life.

Onset:

Most patients experience benefits quite soon after recovery.

Recovery

Post-procedure Care:

• Monitoring in the intensive care unit for 24-48 hours.
• Gradual resumption of activities as tolerated.

Recovery Time:

• Full recovery often occurs within 1-2 weeks.
• Follow-up appointments to monitor valve function and overall health.

Alternatives

Other Treatment Options:

• Medical management with medications.
• Traditional open-heart surgery for valve replacement.

Pros and Cons:

• TAVR is less invasive with quicker recovery but might not be suitable for all patients.
• Open-heart surgery may be more definitive but comes with higher immediate risks and longer recovery.

Patient Experience

During the Procedure:

• Under general anesthesia or sedated, patients should be comfortable and unaware of the procedure.

After the Procedure:

• Some discomfort or mild pain at the incision site.
• Pain management through prescribed medications.
• Gradual improvement in symptoms and energy levels.