Catheter-based valve replacement (TAVI) for aortic valve stenosis

This catheter-based aortic valve replacement (TAVI) is increasingly being performed on patients with a low surgical risk due to the good clinical results and the gentle procedure. In addition, TAVI is also suitable for patients who have previously had a biological aortic valve prosthesis (valve-in-valve) if these have degenerated.

In contrast to the surgical procedure, in a TAVI our specialists perform the implantation using a catheter - on the beating heart, without connecting the patient to a heart-lung machine, and the valve can be inserted into the diseased aortic valve using a catheter via various access routes:

I) Transfemoral TAVI via the inguinal artery (80 to 90%)

Transfemoral means that access is via the groin arteries. Specialists use a puncture in the groin to push a folded, biological heart valve to the beating heart using a catheter. The biological heart valve prosthesis is placed or anchored in the area of the narrowed and calcified aortic valve.

II) Transapical TAVI via the apex of the heart

In patients with too small and/or severely calcified inguinal vessels, transapical TAVI may be considered, in which access is via the apex of the heart. The new heart valve is implanted through an approximately four centimetre long incision in the chest wall (2).

III) Trans-subclavian TAVI

TAVI intervention via the subclavian artery or carotid artery.

IV) Transaortals TAVI

In this case, TAVI implantation is performed via a puncture of the ascending aorta (3)

Operation access

There are three different approaches to catheter-based calf replacement (TAVI): the puncture of the groin (1), the incision in the chest wall (2) or the puncture of the aorta (3).

Surgical access via the groin

For catheter-based valve replacement (TAVI), there are various approaches to choose from: puncture of the groin (1), incision in the chest wall and access via the apex of the heart (2), puncture of the aorta (3) or the subclavian artery or carotid artery (4). Access via the groin is possible in over 95% of cases and is the standard access. Surgical opening of the access vessel is required for the other accesses.

TAVI therapy is much less stressful than conventional heart surgery. As the rib cage or sternum remains intact and there is no need for a heart-lung machine, the patient can be mobilized on the day of the procedure and leave the hospital after a few days.

The TAVI procedure is now the standard procedure for most patients with aortic valve stenosis. Anatomical factors and additional diseases play a decisive role in the preliminary discussion in the HEARTTEAM. A detailed preliminary clarification is therefore important in order to be able to individually define the best therapy (choice of access route, valve type, size and risks).

Current studies confirm the value of TAVI compared to surgical valve replacement (comparable procedural success and low complication rates).