Transcatheter Aortic Valve Replacement
In today’s age, advancements are always being discovered or made. Advancements have become so common that often times they go unnoticed. For instance, when was the last time you heard about a break through in the cardiology field? I know from personal experience, I do not hear about advancements unless they have a direct link to me. Due to this, I decided to talk about a new procedure known as a Transcatheter Aortic Valve Replacement (TAVR), to discuss how this new advancement has transformed cardiology.
What is TAVR?
TAVR is a new treatment option for high risk heart patients who cannot withstand a regular open heart surgery procedure. TAVR is a minimally invasive surgery that replaces a patient’s aortic valve without opening up their chest or removing the previous aortic valve. The team members required for a TAVR procedure to go underway is three cardiac surgeons, upwards of twelve nurses, two imaging specialists, and a cardiac anesthesiologists.
How are surgeons able to do this?
There are three approaches to the TAVR procedure. Surgeons can reach the aortic valve through a transfemoral approach, a transapical approach, or a transaortic approach. These approaches consist of either making an incision at the groin (Transfemoral), under the rib cage (Transapical), or at the neck (Transaortic). Through testing, surgeons will decide which approach out of the three will work the best for the patient’s needs and body type. Once the surgeons make the decision of which approach they will use, they will begin to work their way up (or down) to the aortic valve microscopically. Once they reach the aortic valve successfully, a balloon stint at the end of the microscope will expand pushing the original valve open to allow blood to flow through successfully.
What makes people a good candidate for this surgery?
People who undergo a TAVR procedure most often have a condition known as aortic stenosis. Aortic stenosis is simply the narrowing of the opening of the aortic valve. The narrowing causes the aortic valve to not be able to open fully, causing the blood flow to the rest of the body to diminish. This causes the heart to have to work harder which will ultimately lead to heart failure and then death. The leading causing factor of aortic stenosis is calcium build up or scar tissue. The calcium build up is what puts patients at such a high risk for a normal open heart surgery. For instance, in a normal surgery the surgeons will clamp off the valve to not allow blood flow and remove it. They replace the original valve with a new valve. This seems easy enough; however, if a patient has a calcium build up the surgeons are unable to clamp off the valve adequately; thus, allowing blood to flow through. With the movement of blood, the calcium deposits can break off and enter the blood stream causing the calcium to go to the brain. When the calcium enters the brain, it can cause brain damage, a stroke, and death. Therefore, most patients who are eligible for the TAVR procedure have either had an unsuccessful open heart surgery or have been labeled inoperable.
How has TAVR transformed cardiology?
TAVR has been a breakthrough in cardiology to give patients with aortic stenosis a treatment option. In past times, people with this condition had no other option. They were either labeled as too risky to operate on and given the time that they have left, or surgeons risked a regular open heart surgery normally resulting in a fatality. Due to the advancement with TAVR, people are now able to be treated; thus, given more time. Without TAVR, many people with aortic stenosis would not have been granted the time that they have now. TAVR has been a major breakthrough and through more advancements, it will continue to transform cardiology.
This article is based off of personal experiences and personal research. The claims within this article are backed through the following link and my own personal experiences with the treatment option:
Catheter Cardiovasc Interv. 2014 Nov 1;84(5):834-42. doi: 10.1002/ccd.25356. Epub 2014 Feb 3. Evaluation Studieswww.ncbi.nlm.nih.gov
The link provides further in depth discussion about TAVR and specific results an institution has found with practicing TAVR.