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15.12.2018 05:33:16
Narrowing of the aortic valve in old age is not uncommon. The cause is most often calcification. Because of the narrowed aortic valve, less oxygen-rich blood enters the body. Patients quickly feel short of breath; in everyday life they become less and less able-bodied. The problem can be solved with the help of a new aortic valve. It can be replaced either as part of “open chest” surgery or minimally invasively by the use of a catheter during the so-called transcatheter aortic valve implantation (TAVI).
The aortic valve is made from bovine or pig pericardial tissue and is strengthened with a wire mesh. Aortic valve replacement through surgery is considered a well-established, recognized method. The new valve is mounted very securely. What concerns transcatheter interventions, there has been great progress in their development over the last ten years. This method is used more often. A compactly folded new valve on a wire guide is delivered to the heart through the femoral artery. There, by using a balloon catheter the old valve is opened, but not removed. In its place, the new valve is stretched open and fastened.
Which method to use in a particular case should be determined by a trained team consisting of a cardiologist and a cardiac surgeon. Therefore, for heart valve surgery, it is recommended to contact the clinic offering both methods. Here is a brief overview of their advantages and disadvantages.
| Surgery | Catheter (TAVI) |
| + the old aortic valve is removed | - the old aortic valve is opened |
| + the new valve is sutured | - the new valve is pressed into |
| + routine intervention | - experience is still being gained |
| - deep anesthesia | + no deep anesthesia |
| - dissection of the sternum | + sternum remains intact |
| - opening of the pericardium | + the pericardium is not opened |
| - the heart must remain motionless | + the intervention is performed on a beating heart |
| - requires cardiopulmonary bypass | + the heart-lung machine is not required |
Until now, transcatheter aortic valve implantation was considered an option only for patients who would have endured traditional surgery with difficulties. However, TAVI technique is increasingly used in young patients. This fact demands much of implanted valves lifespan, as younger patients are expected to live definitely longer with a new heart valve.
As part of a study, Canadian scientists by using heart ultrasound found out how long the prostheses implanted via TAVI work without failures. While in the first years they, as a rule, did not cause any problems, eight years after implantation about half of the implanted prostheses wore out appreciably, especially in patients with chronic kidney diseases.
The study was conducted on the durability of the first generation aortic valves. Nowadays, advanced prostheses are used, the service life of which has not been studied yet.
