TAVI (Transcatheter Aortic Valve Implantation)
1. Transcatheter Aortic Valve Implantation (TAVI)
The treatment of choice for severe aortic stenosis in elderly is now transcatheter aortic valvular implantation. This procedure involves implanting a balloon expandable stent inside the diseased aortic valve.
2. Preoperative Assessment
To determine whether this procedure is suitable for a particular patient, a multidisciplinary team of cardiologists and cardiac surgeons, Anesthetists assesses the individual's medical history, physical examination, laboratory results, imaging studies, and any previous surgical procedures. More critical part of assessment is CT aortogram
3. TAVI Procedure
Once the decision to proceed with TAVI is made, patients are taken into cathlab, where the procedure is done under conscious sedation or local anesthesia. (There is no need for general anesthesia or endotracheal intubation). Femoral artery is punctured, a small sheath is placed. Next, a guide wire is advanced through the femoral artery into the left ventricle. Finally, the balloon-expandable valve is introduced through the femoral artery and positioned at the level of the aortic annular ring and valve is deployed by inflating the balloon. once deployed, balloon is deflated and taken out. Femoral sheath removed and puncture site is closed using closure device
4. Postoperative Care
After the procedure, patients are monitored closely in the intensive care unit for few hours. Blood pressure, pulse oximetry, electrocardiography, and temperature are measured every few minutes. Patients typically are made to ambulate within 6-8 hours, remain in hospitalized overnight and are usually able to return home within one to two days after the procedure.