Making Heart Decisions For A Safer Procedure

A transcatheter aortic valve implantation (TAVI) eliminates the need for open-heart surgery, lowering the risks involved in cardiac care

Featuring Dr Paul TL Chiam

A new technique called transcatheter aortic valve implantation (TAVI) presents a less invasive treatment option for aortic stenosis, and eliminates the need for open-heart surgery.

Tavi Procedures Are Less Invasive And Can Be Done On Local Anaesthesia

Aortic stenosis is where the aortic valve becomes narrowed due to long-term build-up of calcium deposits, leading to degeneration of the leaflets around the valve opening, which subsequently become stiff and immobile – greatly obstructing blood flow. In the past, risky open-heart surgery to replace the valve was the best available option for severe cases.

During a TAVI procedure, catheters are fed through a small incision in the groin. An artificial valve – comprising of a tissue mesh nestled within a frame-like stent – is inserted into the heart via the femoral artery; the tissue mesh essentially replaces the native leaflets. Due to the nature of the procedure, it can even be performed on local anaesthesia.

2nd Generation Valves Have Enhanced Safety Over Its Predecessors

However, the artificial valve may have a 25-30% chance of suboptimal positioning, leaving residual mild to moderate leaks between the newly implanted valve and the native tissue. The CoreValve Evolut R valve, a new and advanced 2nd generation TAVI valve, has enhanced safety and accuracy over older models. The Evolut R valve allows doctors to recapture or reposition the valves to a more optimum position; or replace them with a differently-sized implant – an improvement over its predecessors.

In the case of 80-year-old patient Ms. Amelita Go, who was diagnosed with severe breathlessness caused by aortic stenosis, she was found to possess other conditions that could complicate her heart procedure. She had a very narrow aortic root and low left coronary artery. Due to the narrow aortic root, an additional procedure – a root enlargement – would be required during surgical valve replacement, which would greatly increase the risk of the surgery. A TAVI procedure also ran the risk of blocking off the left coronary artery, resulting in a heart attack or even death.

“SAFETY Was Enhanced With The Newer Valve”

Ms. Go became the first person in Asia to receive the Evolut R valve at Mount Elizabeth Hospital Novena, the first private hospital in Asia to have utilised this new technology. Her surgeon, senior consultant cardiologist Dr. Paul Chiam, is the first cardiologist in the hospital to have successfully performed the TAVI procedure using the Evolut R valves.

“Being able to reposition the valve minimises residual leakage and improves symptom relief and survival. Furthermore, in case her left coronary artery became blocked, we could have recaptured the valve; this wasn’t possible with the 1st generation valve. Thus the procedural safety was enhanced with the newer valve,” explained Dr. Chiam. After a successful procedure, the patient went on to have a full recovery.

Significant Improvement In Patient Outcomes

As in the case of Ms. Go, advanced age or other risk factors may seriously complicate any procedure. The Evolut R valve system significantly reduces the risk factors of TAVI procedures, even for those with severe aortic valve narrowing at high surgical-risk. Ultimately, patients will have an improved outcome and a better quality of life.


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