Percutaneous aortic valve replacement

Percutaneous Aortic Valve Replacement

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Percutaneous Aortic Valve Replacement Procedure

Percutaneous aortic valve replacement (PAVR), also known as transcatheter aortic valve replacement (TAVR), is a minimally invasive procedure used to treat aortic valve stenosis. It involves replacing a diseased aortic valve with a prosthetic valve through a catheter, without the need for open-heart surgery.

Procedure

The PAVR procedure is typically performed in a cardiac catheterization laboratory or hybrid operating room. The patient is placed under general anesthesia, and a small incision is made in the groin or chest to access the femoral artery or the left ventricle, respectively.

A catheter with a collapsible prosthetic valve is then inserted through the incision and guided to the site of the diseased aortic valve. The new valve is positioned within the native valve, and once properly aligned, it is expanded using a balloon or a self-expanding mechanism. The expanded valve pushes the old valve leaflets aside, allowing blood to flow through the new valve.

Advantages

PAVR offers several advantages over traditional open-heart surgery for aortic valve replacement:

1. **Minimally Invasive**: PAVR is a less invasive procedure compared to open-heart surgery, as it does not require a sternotomy (opening of the chest) or the use of a heart-lung machine. This results in reduced trauma, shorter hospital stays, and faster recovery times.

2. **Suitable for High-Risk Patients**: PAVR is particularly beneficial for patients who are considered high-risk or inoperable for open-heart surgery due to age, frailty, or other comorbidities. It provides a viable treatment option for these patients who would otherwise have limited options.

3. **Reduced Complications**: PAVR has been associated with lower rates of complications such as bleeding, infection, and stroke compared to open-heart surgery. The minimally invasive nature of the procedure reduces the risk of surgical site infections and other post-operative complications.

Risks and Limitations

While PAVR offers significant advantages, it is not without risks and limitations:

1. **Vascular Complications**: The insertion of the catheter through the femoral artery can lead to vascular complications such as bleeding, hematoma, or damage to the artery. Alternative access sites, such as the subclavian artery or the apex of the heart, may be used to mitigate these risks.

2. **Paravalvular Leak**: In some cases, the prosthetic valve may not completely seal against the native valve, resulting in a paravalvular leak. This can lead to symptoms such as shortness of breath or decreased exercise tolerance. However, advancements in valve design and implantation techniques have significantly reduced the occurrence of paravalvular leaks.

3. **Limited Valve Sizes**: The available sizes of prosthetic valves for PAVR are limited compared to surgical valves. This can pose challenges in achieving an optimal fit for patients with larger or smaller aortic annuli.

Conclusion

Percutaneous aortic valve replacement is a minimally invasive procedure that offers a viable treatment option for patients with aortic valve stenosis, particularly those who are considered high-risk or inoperable for open-heart surgery. It provides numerous advantages, including reduced trauma, shorter hospital stays, and faster recovery times. However, it is important to consider the potential risks and limitations associated with the procedure. As technology continues to advance, PAVR is expected to become an increasingly common and effective treatment option for patients with aortic valve disease.

See Also

• Aortic Valve Stenosis
• Cardiac Catheterization
• Heart Valve Replacement
• Minimally Invasive Surgery