Aortic valve stenosis is a common condition among the elderly, especially those aged 75 and above. It occurs when the aortic valve—located between the left ventricle of the heart and the aorta—becomes abnormally narrowed or stiffened. This forces the heart to work harder to pump sufficient blood to the rest of the body.
Common symptoms of aortic stenosis include shortness of breath, chest pain, dizziness, or fainting. If left untreated, it can lead to heart failure or even death.
Transcatheter Aortic Valve Implantation (TAVI) is an innovative, minimally invasive procedure that replaces the aortic valve using a catheter, without the need for open-heart surgery.
Causes and Risk Factors of Aortic Valve Stenosis
Aortic valve stenosis can result from various causes and contributing factors, with the most common including:
- Age-related valve degeneration – As people age, the valve tissue thickens, which limits the ability of the valve to open fully.
- Calcium buildup on the valve – Often associated with aging, calcium deposits can cause the valve to become stiff, restricting proper opening and closing.
- Congenital aortic valve abnormalities – Some individuals are born with an aortic valve that has only two leaflets (bicuspid valve) instead of the normal three. This condition can lead to premature valve degeneration and early-onset stenosis.
- Rheumatic heart disease – Caused by a streptococcal infection (Group A Streptococcus) during childhood or adolescence, it can lead to inflammation and damage to the heart valves, eventually causing stenosis later in life.
In addition, several chronic conditions such as diabetes, high blood pressure, and high cholesterol, along with lifestyle factors like smoking, obesity, and genetic predisposition, also increase the risk of valve deterioration and hasten the onset of stenosis.
What is TAVI? An Innovative, Minimally Invasive Aortic Valve Replacement
TAVI (Transcatheter Aortic Valve Implantation) is an innovative procedure used to treat severe aortic valve stenosis without the need for traditional open-heart surgery. Instead of opening the chest, a catheter is inserted through a blood vessel—most commonly via the femoral artery in the groin (transfemoral approach). In some cases, the catheter may be inserted through other access points, such as the chest (transaortic), subclavian artery, or other suitable sites depending on the patient’s anatomy and condition.
A specially designed catheter carrying a bioprosthetic heart valve—made from biological tissue and supported by a metal stent—is guided to the narrowed native valve. Once correctly positioned, the new valve is deployed either by balloon expansion or a self-expanding stent mechanism, replacing the damaged valve and restoring proper blood flow from the heart. This relieves symptoms such as shortness of breath, fatigue, and reduces the risk of heart failure and left ventricular hypertrophy in the future.
Typically, the TAVI procedure takes around 2 to 3 hours. Most patients receive local anesthesia or conscious sedation, avoiding the need for general anesthesia as required in open-heart surgery. After the procedure, only a small puncture wound remains—usually at the groin or wherever the catheter was inserted.
Benefits of Transcatheter Aortic Valve Implantation (TAVI)
TAVI offers several key advantages over traditional open-heart surgery:
- Minimally invasive with smaller incisions – The incision required for catheter insertion is only about 0.5–1 cm, compared to the 15–20 cm incision across the chest required for open-heart surgery. This significantly reduces pain and tissue trauma.
- Lower risk of serious complications – Due to the small incision and reduced need for general anesthesia, TAVI carries a lower risk of major complications such as excessive bleeding or bloodstream infections.
- No need to stop the heart during the procedure – This reduces the risk of heart muscle injury and other related complications.
- Shorter recovery time – Patients typically stay in the ICU for only 1–2 days and are discharged from the hospital much sooner than after open-heart surgery.
- Faster return to daily life – Quicker recovery enhances quality of life and reduces the emotional and physical stress associated with long hospital stays.
- Rapid symptom relief – Symptoms such as shortness of breath and chest pain often improve within 24–48 hours after the procedure.
- High treatment success rate – TAVI has a success rate of over 95%, significantly improving blood flow to the body. The implanted valve also has a long lifespan, often lasting 10 years or more.
Who Is a Good Candidate for TAVI?
TAVI is an appropriate treatment for patients with severe aortic stenosis who are not suitable candidates for traditional open-heart surgery or who are at high surgical risk. This includes:
- Elderly patients, especially those aged 75 years and older, particularly those with high surgical risks—such as a history of chest radiation or extensive calcification of the aortic wall.
- Patients with multiple underlying health conditions, such as chronic lung disease, kidney disease, diabetes, coronary artery disease, or aortic atherosclerosis.
- Patients who have previously undergone heart surgery and are not ideal candidates for repeat open-heart procedures.
Limitations and Precautions of TAVI for Aortic Valve Stenosis
While TAVI offers numerous benefits, there are certain limitations and precautions that must be considered. In some cases, a patient’s health condition may make them unsuitable for this procedure, such as:
- Active bloodstream infections, which carry a high risk of spreading infection and causing serious complications.
- Recent stroke patients who are unable to take blood-thinning medications.
- Presence of blood clots in the heart chambers, which increases the risk of embolism or stroke following the procedure.
- Patients requiring concurrent coronary artery bypass surgery (CABG), where traditional open-heart surgery is more appropriate.
- Severe arrhythmias or acute heart failure at the time of treatment.
- Narrow or severely abnormal blood vessels, which can make catheter insertion and valve deployment difficult or risky.
Additionally, there are potential risks and complications after the TAVI procedure that require close monitoring, such as:
- Bleeding at the catheter insertion site
- Irregular heart rhythms, which may require the implantation of a pacemaker
- Stroke or embolism, although these are relatively uncommon
- Temporary kidney dysfunction due to contrast dye used during the procedure
- Valve displacement, which may require repeat surgery to correct
If you or a loved one is experiencing symptoms related to heart valve disease or has been diagnosed with aortic valve stenosis, you are welcome to seek consultation at the Heart Center, Phyathai 2 Hospital. Our team of specialized cardiologists is ready to guide you through every step—from screening and diagnosis to advanced treatment, including Transcatheter Aortic Valve Implantation (TAVI) using the latest medical technologies. We provide care under the Value Healthcare concept, giving you choices at every stage of treatment and access to personalized services designed to maximize both your satisfaction and treatment outcomes.
