Interventional procedure overview of transcatheter aortic valve implantation for native aortic valve regurgitation

What the procedure involves

TAVI provides a less invasive alternative to open cardiac surgery for the treating AR, avoiding the need for cardiopulmonary bypass and median sternotomy. 

TAVI is usually done under local anaesthesia with sedation. Or it may be done under general anaesthesia. Imaging guidance, including transoesophageal echocardiography (if general anaesthesia is used), fluoroscopy, or angiography , is used to help with prosthetic valve size selection, valve positioning and assessing the implanted valve post procedure. Before and during the procedure, prophylactic antibiotics and anticoagulation medication are administered. 

A bioprosthetic aortic valve is implanted within the damaged native aortic valve. Access to the aortic valve can be percutaneous, with entry to the circulation through the femoral artery (endovascular approach). Alternatively, subclavian access may be used if the anatomy of the femoral arteries is not suitable. Deciding how to achieve catheter access to the aortic valve may depend on a number of factors related to the person having the procedure such femoral artery anatomy and the presence of aortic calcification.

The new prosthetic valve is manipulated into position and deployed over a guide wire passed through the native aortic valve. 

Rapid ventricular pacing is used to temporarily reduce cardiac motion and blood flow through the native aortic valve during placement of the new prosthetic aortic valve. The new valve may be mounted on a metal stent that is self-expanding. Or it may be expanded by inflating a large balloon on which the stented valve has been crimped. Positioning the new valve obliterates the native aortic valve. The catheter is removed once the valve has been successfully placed. 

Different devices are available for this procedure and contain material derived from animal sources.