TAVR/TAVI in Replacing Heart

Introduction:

Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), has emerged as a groundbreaking alternative to traditional open-heart surgery for patients with severe aortic stenosis. This case study illustrates the successful application of TAVR/TAVI in replacing heart valves without the need for open-heart surgery, highlighting its efficacy and safety in improving patient outcomes.

Challenges:

Frailty and comorbidities: Mrs. Y’s advanced age and medical comorbidities posed a challenge for conventional open-heart surgery, necessitating a less invasive approach.
Access site: Assessment of vascular access was crucial to ensure safe delivery and deployment of the transcatheter valve, particularly in elderly patients with vascular disease.
Procedural planning: Comprehensive pre-procedural imaging and multidisciplinary consultation were essential to assess valve morphology, select appropriate valve size, and anticipate potential complications.

Procedure:

Under conscious sedation and local anesthesia, transfemoral access was obtained using percutaneous techniques. Transesophageal echocardiography (TEE) and fluoroscopy were utilized for real-time imaging guidance during valve deployment. A self-expanding transcatheter valve was successfully positioned within the native aortic valve annulus and deployed using rapid pacing to minimize valve migration.

Post-procedural Course:

Immediate post-procedural assessment confirmed optimal valve positioning and function with mild paravalvular leak. Mrs. Y was transferred to the cardiac intensive care unit for close monitoring of hemodynamic parameters and vascular access site. She experienced a smooth recovery with resolution of symptoms and was discharged home on post-procedural day 2.

Follow-up:

At 1-month follow-up, Mrs. Y reported significant improvement in symptoms with no evidence of valve dysfunction or procedural complications. Serial echocardiographic evaluations demonstrated stable valve function and resolution of paravalvular leak, indicating successful transcatheter valve replacement.

Conclusion:

TAVR/TAVI represents a paradigm shift in the management of severe aortic stenosis, offering a less invasive alternative to surgical valve replacement for high-risk patients. This case underscores the safety, efficacy, and feasibility of TAVR/TAVI in replacing heart valves without open-heart surgery, particularly in elderly patients with multiple comorbidities. Multidisciplinary collaboration and individualized patient selection are paramount for achieving optimal outcomes in TAVR/TAVI procedures.