Transcatheter aortic valve implantation for aortic stenosis

Transcatheter aortic valve implantation (TAVI) aims to provide a less invasive alternative to open cardiac surgery for treating aortic stenosis, avoiding the need for sternotomy and cardiopulmonary bypass.

TAVI may be done with the patient under general anaesthesia or using local anaesthesia with or without sedation. Access to the aortic valve is most commonly transluminal, through a large artery (usually the femoral or subclavian artery; percutaneous or endovascular approach), or occasionally surgical, by a minithoracotomy with apical puncture of the left ventricle (transapical approach). The choice of access route (transluminal or transapical) depends on various patient-related factors including atherosclerotic disease in the arteries, which would make the transluminal approach impossible.

Initially the aortic valve ring may be dilated using a balloon catheter, which is advanced over a guidewire. The new prosthetic valve is manipulated into position and inserted inside the existing aortic valve.

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