Heart valves are 'doors' that control the flow of blood between the different chambers or parts of the heart.
Patients will start experiencing symptoms at different ages depending on the type of Heart Valve Disease that they have. This can range from the very young to the very old.
You could visit your family doctor who will take a detailed history, do a thorough physical examination and order the necessary tests. Your doctor may refer you to a cardiologist for further evaluation. The cardiologist may do an echocardiogram, a painless test using ultrasound, to help him look at your heart and its different structures.
Depending on what is found, you may be:
How should you prepare for the surgery?
What happens during the surgery?
What are the potential risks or complications?
Why is Transcatheter Aortic Valve Implantation (TAVI) needed?
What can I expect before the procedure?Before the procedure, you will undergo routine investigations to evaluate whether TAVI is possible,and which of the two techniques for TAVI (Transfemoral or Transapical route) is most appropriate for you. The investigations will also identify any other considerations that need to be addressed for your treatment.
Two approaches of TAVIWhether you are selected to undergo the transfemoral or the transapical approach, this procedure will be performed under general anesthesia. As the heart is not opened to expose the aortic valve, fluoroscopy (X-rays) and transesophageal echocardiography (ultrasound) are used to visualise the heart and THV, and to guide the insertion of the THV. The duration of X-ray exposure that you will receive will normally be less than 30 minutes, the normal length of time it takes for a coronary artery procedure in the cardiac catheterisation laboratory.
What happens after the procedure?After the TAVI procedure, you will be transferred to either the CCU ward or the CTICU ward for close monitoring. When you are first transferred, you may be under sedation and on ventilatory support. Over the course of the next 24 hours, you will be awakened from the sedation and allowed to breathe on your own with the ventilation tube removed. You will remain in the CCU or CTICU ward until your doctor feels that you can be transferred to a regular hospital ward, where you will continue to be monitored until your discharge from the hospital, usually within 5 – 7 days.
What are the potential risks/complications of the procedure?Like any other operations, there are risks associated with this procedure. However, the long-term risk to your life and your quality of life may be higher if severe Aortic Stenosis is not treated.
What can I expect before the procedure?Some investigations would need to be performed before the procedure. These include but are not limited to a transthoracic and transesophageal echocardiogram (ultrasound test for the heart). These two tests will allow for more accurate assessment of the mitral valve to determine if mitraclip therapy is suitable. Other tests such as coronary angiograms, electrocardiograms, chest X-rays and blood tests may also be needed prior to the procedure.
The ProcedureThe mitraclip therapy procedure is done under general anesthesia and takes approximately 3 to 4 hours. A catheter (long thin flexible tube) is guided through the femoral (leg) vein to reach the heart. The clip is delivered through the catheter to the region of the mitral valve. Upon reaching the mitral valve, it clips the mitral valve to allow it to close better. The clip is left on the mitral valve while the rest of the delivery system and the catheter are removed.
What happens after the procedure?After mitraclip therapy procedure, you will be transferred to the cardiac monitoring unit for a day. After this, your cardiologist would review you and may transfer you to the regular hospital ward for the next two days before discharge. Additional tests would be performed after the mitraclip therapy procedure. These include a repeat transthoracic echocardiogram, blood tests and a chest X-ray. You may also be given blood thinners such as aspirin and or clopidogrel for six months.