Our Summary

This research paper discusses a case where a patient with aortic stenosis - a condition where the heart’s aortic valve narrows - needed to undergo a procedure called Transcatheter Aortic Valve Replacement (TAVR). Normally, doctors perform this procedure through the patient’s femoral artery in their leg, using either local or general anesthesia to manage the patient’s pain and comfort. However, for this particular patient, doctors could not use the usual method and had to find an alternative approach.

The doctors decided to perform the procedure through the patient’s carotid artery in their neck, using regional anesthesia to numb a specific area of the body and monitored anesthesia care to control the patient’s comfort. The process was carried out by a team of heart specialists. The paper suggests that this alternative method could be used in future cases where the standard approach isn’t possible.

FAQs

  1. What is transcatheter aortic valve replacement (TAVR) and who is it for?
  2. What are the different approaches to TAVR and when are alternative access required?
  3. What is a transcarotid approach to TAVR and how is it performed?

Doctor’s Tip

One helpful tip a doctor might tell a patient about aortic valve replacement is to follow all pre-operative instructions provided by the medical team, including fasting guidelines and medication adjustments. It is also important to communicate any concerns or questions with your healthcare provider and to follow all post-operative care instructions closely to ensure a successful recovery. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support the long-term success of the valve replacement procedure.

Suitable For

Patients who are typically recommended for aortic valve replacement include those with severe aortic stenosis who are considered high surgical risk. This may include elderly patients, patients with multiple comorbidities, or those who are not candidates for traditional surgical aortic valve replacement. Transcatheter aortic valve replacement (TAVR) is often recommended for these patients as it is a less invasive procedure with a quicker recovery time compared to open heart surgery. In some cases, alternative access TAVR may be required if transfemoral access is not possible. These patients may benefit from a transcarotid approach to TAVR with regional anesthesia and monitored anesthesia care. A multidisciplinary heart team will assess each patient individually to determine the most appropriate treatment plan for their specific needs.

Timeline

Before aortic valve replacement:

  • Patient undergoes initial evaluation and diagnostic tests to confirm the need for aortic valve replacement
  • Patient consults with a cardiologist and cardiac surgeon to discuss treatment options and decide on the best approach for the procedure
  • Pre-operative testing and preparation, including blood work, imaging studies, and cardiac catheterization
  • Patient may need to stop taking certain medications or make lifestyle changes in preparation for surgery

After aortic valve replacement:

  • Patient is closely monitored in the recovery room for any complications or adverse reactions to the procedure
  • Patient may stay in the hospital for a few days for further monitoring and rehabilitation
  • Follow-up appointments with the cardiologist and cardiac surgeon to assess recovery and adjust medications as needed
  • Cardiac rehabilitation program to help the patient regain strength and endurance post-surgery
  • Long-term follow-up care to monitor the function of the new valve and overall heart health.

What to Ask Your Doctor

  1. What is the reason for needing an aortic valve replacement?
  2. Are there any alternative treatment options to consider?
  3. What is the success rate of the procedure?
  4. What are the potential risks and complications associated with the surgery?
  5. What is the recovery process like and how long is the expected recovery time?
  6. Will there be any lifestyle changes or restrictions after the procedure?
  7. How long will the new valve last and will any additional procedures be needed in the future?
  8. Will there be any ongoing medication or follow-up appointments required?
  9. What experience does the medical team have with performing aortic valve replacements?
  10. Are there any specific pre-operative or post-operative instructions that need to be followed?

Reference

Authors: El-Andari R, Kang JJ, Sidhu S, Cwinn M, Green J, Ma ML, Mathew A, Tyrrell BD, Welsh RC, Nagendran J. Journal: Future Cardiol. 2024;20(9):447-451. doi: 10.1080/14796678.2024.2378648. Epub 2024 Sep 23. PMID: 39311081