Transcatheter Aortic Valve Implantation (TAVI)

 

Transcatheter Aortic Valve Implantation (TAVI) – a procedure that replaces the aortic valve without chest incision or anaesthesia, was recently successfully performed on an 80-year-old patient by Bangabandhu Sheikh Mujib Medical University (BSMMU) cardiologist Prof Dr SM Mustafa Zaman.

 

As we age, calcium builds up in the valves. In some cases, the diameter of the valve opening may be one square centimeter or less.  As a result, the heart has to exert more force to push blood into the aorta. It causes many physical problems. This type of aortic valve problem can usually start after the age of 60-65 years. TAVI involves inserting a catheter into a blood vessel in your upper leg or chest and guiding it to your aortic valve. As a result, the heart has to exert more force to push blood into the aorta. It causes many physical problems. This type of aortic valve problem can usually start after the age of 60-65 years. TAVI involves inserting a catheter into a blood vessel in your upper leg or chest and guiding it to your aortic valve. Earlier, if there was a problem with the aortic valve or if this valve had to be replaced, the help of open heart surgery had to be taken. In this case, a wound of about 7 to 8 inches is formed on the patient's chest. Even during the operation, the patient had to be kept under the supervision of the heart-lung machine.

 

The TAVI method does not require such extensive harvesting. The procedure is similar to the angioplasty procedure. In this case, too, the catheter is inserted into the femoral artery through the groin. This catheter is advanced into the aorta, behind the narrow aortic valve, and into the left ventricle. It is then passed through the catheter.

 

A balloon catheter is inserted over this wire. A stent is placed around the balloon. And the new valve is sewn inside the stent. The balloon is moved to the old valve and inflated. As the balloon inflates, the narrow face of the valve also expands. This procedure also loosens the stent surrounding the balloon. And the old valve is replaced with a new valve sewn together with a stent.

Responding to a question about the benefits of TAVI, Dr. Zaman said, the patient does not have a large chest wound. Do not stay in the hospital for more than two to three days. No ventilation is required. Consequently, the TAVI procedure is highly effective for aortic valve replacement in the elderly, who typically have multiple co-morbidities. Open heart surgery in such patients is risky, and TAVI is very low risk in all these cases.

The operation was successful at BSMMU and the patient was discharged from the hospital. Dr Zaman said this is an important milestone in the public sector. He noted that the cost of the TAVI procedure in Bangladesh is about one-fifth that of some foreign countries. It can help Bangladeshi patients to a great extent. He sought the government's cooperation in serving the deserving patients of the country.