Catheter-guided procedure for the treatment of high-grade narrowing and calcification of the aortic valve (aortic valve stenosis). In individual cases, the therapy of a leaky aortic valve (aortic valve insufficiency) is also possible if anatomically suitable.
The main symptoms of this clinical picture are shortness of breath during exertion and later also at rest (dyspnea), a feeling of tightness in the chest (angina pectoris) and/or fainting (syncope).
The following preparatory examinations are necessary: Cardiac ultrasound (echocardiography), cardiac catheterization with imaging of the coronary vessels and, if necessary, a measurement of the pressure values in the pulmonary circulation, computer tomography with imaging of the heart and the access vessels.
The procedure is usually performed under local anesthesia; general anesthesia is not necessary. Via the inguinal artery (femoral artery) and main artery (aorta), the biological heart valve “folded” onto a catheter system is positioned and released into the narrowed and calcified aortic valve under X-ray fluoroscopy. Blood flow over the valve is minimized during valve release by rapid pacing of the heart via a temporarily inserted pacemaker probe. A basic distinction is made between balloon-expandable and self-expanding valve systems. The individually optimal system is selected on the basis of the anatomical conditions. The catheter system is then removed and the puncture sites in the area of the access vessels are sutured. The procedure takes approximately 30-60 minutes.
In addition, this procedure can also be used to treat patients with worn (degenerated) biological heart valves after surgical replacement of the aortic or mitral valve (see Valve-in-Valve Therapy).
Patients with narrowed leg arteries can be treated via alternative access routes. In addition to surgical access via the cardiac apex, via the aorta or via the subclavian artery, a gentle access via the leg vein (transcaval access) has been established as a safe minimally invasive alternative at our hospital. For patients at particular risk, we use special methods, such as the BASILICA technique, to avoid occlusion of the coronary arteries and thus a heart attack. We also use protection systems to prevent strokes in patients at increased risk.
Balloon dilatation of the aortic valve (aortic balloon valvuloplasty) is often performed in preparation during TAVI, but it is rarely performed as a stand-alone procedure nowadays.
After the intervention, monitoring is necessary for at least twelve hours, and bed rest with a pressure dressing should be maintained for approximately six hours. In total, an inpatient stay of at least two nights must be expected for the intervention.