TAVI: what it is, how it is done and how it changes life after surgery
TAVI, an acronym for Transcatheter Aortic Valve Implantation, is a minimally invasive procedure that allows the replacement of a damaged aortic valve without having to open the chest or resort to traditional open-heart surgery. It is one of the most significant innovations in modern interventional cardiology for the treatment of severe aortic stenosis, a condition that can severely compromise quality of life and life expectancy.
In recent years, this technique has revolutionised the treatment approach, especially in elderly or frail patients, who have clinical conditions that make traditional cardiac surgery more risky. But what happens after the operation? Can one return to a normal life?
At Policlinico San Donato, the national reference centre for TAVI and the first in Italy for the number of procedures performed each year, about 400 operations are performed; hundreds of patients rely on the experience of highly qualified specialists. We interview prof. Francesco Bedogni, director of the Clinical and Interventional Cardiology and Coronary Intensive Care Units (CICU) at IRCCS Policlinico San Donato.
What is aortic stenosis and why is it dangerous
Aortic stenosis is a disease of the aortic valve, which tends to calcify and narrow with age, obstructing the proper passage of blood from the heart to the rest of the body. The aortic valve, one of the four heart valves, is responsible for regulating the flow of blood from the left ventricle to the aorta. When it narrows the heart is forced to work harder to pump blood and, over time, this overload can lead to heart failure and other complications.
"When symptoms appear, the prognosis quickly worsens. Signs that should not be underestimated," explains Professor Bedogni, "are breathlessness, chest pain, fainting, fatigue, and reduced exercise tolerance".
Even everyday activities, such as climbing stairs or walking, can become strenuous. In the absence of treatment, symptomatic aortic stenosis can have a mortality rate of up to 50% two years after diagnosis. For this reason, early diagnosis and specialist care are essential.
How TAVI is performed
TAVI is generally performed under local anaesthesia, via percutaneous access from the femoral artery, at the inguinal level. Via a thin catheter, a new biological valve is transported and placed inside the diseased valve. Compared to conventional surgical valve replacement, TAVI does not require opening of the chest or the use of extracorporeal circulation.
The main advantage is that it is minimally invasive, which allows lower pain, fewer complications and faster recovery times.
Prior to surgery, the patient undergoes extensive examinations including:
● echocardiogram to confirm the severity of the stenosis;
● cardiac and vascular CT scan to study the anatomy of the heart, coronaries and vessels and to choose the most suitable valve size and model;
● electrocardiogram;
● blood tests.
Each case is then discussed by a multidisciplinary Heart Team comprising cardiologists, cardiac surgeons and anaesthetists, to ensure the safest and most effective strategy.
Recovery and quality of life after TAVI
After the operation, the patient is monitored in the sub-intensive care unit or NICU to check the heart rhythm and exclude any complications. In most cases he can get up as early as the next day and discharge takes place after 3-5 days on average.
"Patients often tell us that they feel reborn," Bedogni emphasises. In fact, symptoms tend to reduce or disappear, with a significant improvement in quality of life and survival. Once discharged, it is important to carefully follow the cardiologist's instructions, take the prescribed therapies, and gradually resume daily activities.
How long does a TAVI valve last
Modern TAVI valves have an average lifespan of 8-10 years. In the event of prosthesis degeneration, it is possible to re-operate with a minimally invasive procedure called valve in valve, which allows a new valve to be implanted inside the previous one, avoiding a more invasive operation.
Checks after the operation
After TAVI it is essential to follow a cardiological follow-up programme with check-ups at 1 month, 6 months and then annually. During the check-ups, a cardiological examination, electrocardiogram, echocardiogram and possible blood tests are carried out to monitor the correct functioning of the valve and the possible occurrence of arrhythmias.
"In a minority of cases a pacemaker implantation may be necessary, but in the vast majority of patients the course is rapid and the benefits are evident," concludes Bedogni.
Maintaining a healthy lifestyle, quitting smoking, controlling blood pressure and cholesterol, eating a balanced diet and taking regular exercise are essential to protect the heart in the long term.
