Replace the heart valves without a scalpel: when and how

Replace the heart valves without a scalpel: when and how

Aortic stenosis, now it is possible to intervene even without a scalpel, even on patients under 70

Do you know when a conduit narrows and the liquid it contains cannot pass as it should? In the heart, something similar to what happens in everyday life happens. In fact, there are valves that must open and close properly, otherwise the possibility of interfering with the circulation of blood.

One of these is the aortic valve, which connects the left ventricle with the larger artery from which blood departs throughout the body. If the valve shrinks we talk about stenosis, a very common condition, especially over the years. The picture must be recognized, then, in some cases, cardiologist and cardiac surgeon can think of an intervention to replace the valve.

If once there was talk only of the scalpel to correct this defect, which affects 10% of people over 65, in some cases today it is also possible to resort to implantation without the traditional surgical procedure, with the system called TAVI. This was said by experts in Rome for the Congress of the Italian Cardiology Society.

TAVI: Better results in women

The implant of the aortic valve without a scalpel through a percutaneous route (TAVI), as it is called the operation, has long been applied in selected elderly patients. It has now been recently studied in patients between 65 and 70 years of age with low operative risk, demonstrating its efficacy and a reduction in the risk of stroke.

There is also good news for women who have to undergo a percutaneous implantation of the aortic valve. "For the first time in cardiac interventionism, all published studies show that TAVI implantation is better in women – explains Carmen Spaccarotella, interventional cardiologist at the University Hospital of Catanzaro – although women have smaller arteries. These results are opposite to those obtained in the implantation of coronary stents where the best results are obtained in the male sex. So women with aortic stenosis can be treated with this new minimally invasive technique "

TAVI: how to do the surgery

In traditional open surgery, the patient's chest is opened, the heart is stopped and then the aortic valve is replaced: the operation lasts for hours, is performed under general anesthesia and with extracorporeal circulation, requires a long stay and a long rehabilitation . With TAVI, on the other hand, the only incision is a small hole in the groin, where the catheter that reaches the heart is inserted to bring the new valve and the tools necessary to perform the operation, lasting less than an hour in all .

TAVI: Young and not only

"Until now we implanted heart valves percutaneously only to elderly patients or those with many diseases, with a high operative risk: for these patients, TAVI was a real lifesaver because there were no other safe options to intervene in case of aortic stenosis – explains Ciro Indolfi, president of the Italian Society of Cardiology.

The new data available indicate that TAVI offers the same results as traditional surgery even in younger patients with low operative risk, revealing itself even better in terms of incidence of death, stroke, hospitalization at one year: the risk of stroke, for example, it is reduced by 50 percent. This means that we can avoid a cardiac surgery for thousands of younger patients, understood as a range between 65 and 70. A very positive news, because there is no prevention or drug therapy for aortic stenosis and unfortunately it is a disease in increase.

In Italy, 2 percent of the population in old age, equal to about 250,000 people, have a severe stenosis with indication of replacement surgery; when symptoms appear, life expectancy is dramatically reduced, with an average survival of 2-3 years in people with angina or syncope and only 1-2 years in patients with heart failure. The only effective strategy to lengthen and improve life is to implant a new heart valve.

TAVI represents the greatest technological innovation of Cardiology after coronary stents (ie the tubes that keep dedicated arteries) – adds Indolfi – and the new data that are accumulating, especially the randomized controlled trials published in the New England of Medicine and presented at the last American College of Cardiology they have shown its great efficacy even in low-risk patients ".

Category: Health
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