Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy)
CPT4 code
Name of the Procedure:
Transcatheter Aortic Valve Replacement (TAVR/TAVI) with Prosthetic Valve; Transapical Exposure (e.g., Left Thoracotomy)
Summary
Transcatheter Aortic Valve Replacement (TAVR), also known as Transcatheter Aortic Valve Implantation (TAVI), is a minimally invasive procedure that replaces a damaged aortic valve with a prosthetic valve. In this specific approach, transapical exposure is used, typically involving a small incision in the chest (left thoracotomy) to access the heart.
Purpose
The procedure is designed to treat aortic valve stenosis, a condition where the aortic valve becomes narrowed and restricts blood flow from the heart to the rest of the body. The main goals are to improve blood flow, alleviate symptoms like shortness of breath and chest pain, and enhance the patient's overall quality of life.
Indications
- Severe aortic valve stenosis with symptoms such as chest pain, fainting, or heart failure.
- Patients who are at high or prohibitive risk for traditional open-heart surgery.
Preparation
- Patients may be required to fast for several hours before the procedure.
- Certain medications might need to be adjusted or stopped.
- Diagnostic tests, such as echocardiography, cardiac catheterization, and CT scans, are usually performed to assess the heart and valve structures.
Procedure Description
- The patient is given general anesthesia or sedation.
- An incision is made in the left side of the chest (left thoracotomy) to access the heart through the apex (tip).
- A catheter with the prosthetic valve is guided through the incision and into the heart.
- The prosthetic valve is positioned within the native aortic valve and then expanded to replace the damaged valve.
- Once in place, the new valve starts functioning immediately, and the catheter is removed.
- The incision is closed, and the patient is moved to recovery.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
TAVR with transapical exposure is performed in a hospital, specifically in a cardiac catheterization lab or a hybrid operating room equipped for complex heart procedures.
Personnel
- Cardiothoracic surgeon
- Interventional cardiologist
- Anesthesiologist
- Cardiac nurses
- Radiologic technologists
Risks and Complications
- Bleeding or infection at the incision site
- Valve leakage or misplacement
- Heart attack or stroke
- Arrhythmias (irregular heartbeats)
- Potential need for a permanent pacemaker
Benefits
- Immediate improvement in blood flow and reduction of symptoms.
- Reduced recovery time compared to open-heart surgery.
- Lower risks and faster resumption of daily activities.
Recovery
- Patients are monitored in the hospital for 2 to 5 days.
- Instructions may include avoiding heavy lifting and strenuous activities for a few weeks.
- Follow-up appointments and imaging tests to ensure proper valve function.
- Medications may be prescribed to prevent blood clots and manage other heart conditions.
Alternatives
- Surgical Aortic Valve Replacement (SAVR) via open-heart surgery.
- Balloon aortic valvuloplasty (temporary relief by widening the valve).
- Medical management without surgery for high-risk patients.
Pros and Cons of Alternatives
- SAVR: More invasive with longer recovery time but may be necessary for certain patients.
- Balloon Valvuloplasty: Less invasive but provides only temporary relief.
- Medical Management: Lower risk but often less effective in symptom relief and long-term outcomes.
Patient Experience
- During the procedure, the patient should not feel any pain due to anesthesia.
- Post-procedure, discomfort at the incision site and some general fatigue are common initially.
- Pain management includes medications and comfort measures to aid recovery.