Transcatheter Aortic Valve Implantation (TAVI)

TAVI, called TAVR in North America, replaces a narrowed aortic valve without open surgery. A tissue valve mounted inside a metal frame is compressed onto a catheter, passed up to the heart, usually from the artery in the groin, and expanded inside the old valve, pushing its stiff leaflets aside.

It relieves the breathlessness, chest pain and fainting of severe aortic stenosis and improves survival, with a faster recovery than surgery. Its main uncertainties are long-term durability beyond about 10 years and a higher chance of needing a pacemaker, which is why surgery is still often preferred for younger, low-risk patients.

What Transcatheter Aortic Valve Implantation (TAVI) involves

Planning relies on a gated CT scan that measures the valve ring, the height of the coronary arteries and the calibre of the leg arteries, plus an echo and usually a coronary angiogram. On the day, both groins are numbed. A temporary pacing wire is placed, and a large sheath is inserted into the femoral artery with closure stitches laid in advance. A wire is passed across the narrowed valve. The old valve may be stretched with a balloon, then the new valve is positioned under X-ray. Balloon-expandable valves are deployed during a few seconds of rapid pacing; self-expanding valves are released gradually and can be repositioned. Leak around the valve, coronary flow and heart rhythm are checked before the artery is closed.

Who is a good candidate for Transcatheter Aortic Valve Implantation (TAVI)?

TAVI is for severe, symptomatic aortic stenosis. A heart team weighs age, surgical risk, anatomy and life expectancy to choose between TAVI and surgical valve replacement.

• You are about 75 or older with severe symptomatic aortic stenosis
• You are younger but at raised surgical risk because of lung disease, previous heart surgery, frailty or a calcified aorta
• Your leg arteries are wide enough for the delivery system
• CT shows valve anatomy suitable for a catheter valve
• You have a failing surgical tissue valve suitable for a valve-in-valve procedure

Es ist normalerweise nicht die richtige Wahl, wenn:

• You are under about 65 and low risk, where a surgical valve offers known durability
• Your main problem is a leaking rather than a narrowed aortic valve, with few exceptions
• You have a bicuspid valve with unfavourable anatomy or an enlarged aorta that needs surgery
• You also need bypass grafts or other valve surgery better done in one operation
• You have active endocarditis or a clot in the heart
• Other illness limits life expectancy to under a year or means valve treatment will not improve quality of life

Technikoptionen

• Transfemoral TAVI: Through the groin artery. Used in over 90 in 100 cases and has the best outcomes.
• Alternative access: Through the subclavian or carotid artery, or the tip of the heart, when leg arteries are too small or diseased.
• Balloon-expandable valve: For example the Sapien family. Precise, quick deployment; lower pacemaker rates.
• Self-expanding valve: For example the Evolut or Navitor families. Repositionable; good flow in small valve rings.
• Valve-in-valve TAVI: A catheter valve placed inside a worn-out surgical tissue valve, avoiding repeat open surgery.
• Cerebral protection filter: Optional filters in the neck arteries to catch debris; benefit on stroke is not firmly proven.

Was passiert während Ihrer Behandlung

The procedure takes 1 to 2 hours, mostly under local anaesthetic with conscious sedation; general anaesthesia is used in some cases. You may feel pressure in the groin and a brief fluttering or light-headedness during rapid pacing. Afterwards you are monitored in a coronary care or step-down unit because heart block can appear in the first 48 hours. Typical stay is 2 to 4 nights.

Vorbereitung auf Ihre Reise

A single procedure, but allow 10 to 14 days in Istanbul: 2 to 3 days for CT, echo, angiogram and heart team decision, the hospital stay, then several days for rhythm and groin checks before flying. Sending your echo and any CT in advance shortens this. You need a cardiologist at home for echo follow-up at 1 month and yearly.

• Informieren Sie den Arzt über Medikamente, Allergien, Schwangerschaft oder Stillen und eine Vorgeschichte von Fieberbläschen, Keloidnarben oder Autoimmunerkrankungen
• Vermeiden Sie Alkohol, Aspirin und entzündungshemmende Schmerzmittel für ein paar Tage im Voraus, wenn Ihr eigener Arzt zustimmt, um Blutergüsse zu reduzieren
• Kommen Sie ohne Make-up auf dem Behandlungsbereich an und vermeiden Sie zwei Wochen vorher Sonnenliegen und starke Sonne

Genesung und Ergebnisse

Most people walk the next day and feel easier breathing within days. Avoid heavy lifting for 1 to 2 weeks while the groin heals. Energy improves over 4 to 8 weeks, more slowly if you were very limited before. Blood thinning is usually a single antiplatelet tablet for life, or your existing anticoagulant if you have atrial fibrillation. Antibiotic cover before dental procedures is advised lifelong.

• Zurück zur alltäglichen Aktivität: 1 bis 2 Wochen
• When results show: Breathing improves within days to weeks
• How long they last: At least 8 to 10 years on current data

Sicherheit, Risiken und Revisionspolitik

In current practice death within 30 days is around 1 to 3 in 100, depending on age and general health.

• Need for a permanent pacemaker, in about 5 to 15 in 100 depending on the valve type and your ECG beforehand
• Stroke in about 2 in 100
• Bleeding or damage to the leg artery, sometimes needing a stent or surgical repair
• Leak around the new valve (paravalvular leak)
• Kidney injury from contrast dye
• Blockage of a coronary artery or rupture of the valve ring, both rare and serious
• Clot on the valve leaflets or late infection of the valve
• Valve degeneration over time, with limited data beyond 10 years

Jeder schriftliche Vorschlag wird durch Clinic-Y gibt an, was die Klinik abdeckt, wenn eine Korrektur erforderlich ist. Fragen Sie danach, bevor Sie buchen, nicht danach.

Cost of Transcatheter Aortic Valve Implantation (TAVI) in Türkiye

Clinic-Y does not publish a single price for Transcatheter Aortic Valve Implantation (TAVI), because the honest figure depends on your case. What moves it:

• The valve system used, which is the largest single element
• Access route and whether general anaesthesia is needed
• Pre-procedure CT, angiogram and any coronary stenting
• Nights in monitored care, and a pacemaker if one becomes necessary
• Length of stay in Istanbul for you and a companion

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