TAVI: transcatheter aortic valve implantation

Aortic stenosis is a common condition with age: the aortic valve, which opens with each heartbeat to let blood leave the heart, becomes thickened and calcified and no longer opens enough. It can cause breathlessness, chest pain, dizziness or fainting. When it is severe and causing symptoms, the valve needs to be replaced. TAVI (transcatheter aortic valve implantation) involves bringing a biological valve, folded inside a catheter, up to the heart, most often through the femoral artery at the groin. The new valve is deployed inside the diseased valve, which it pushes aside, and works immediately. The procedure is generally performed under local anaesthesia with sedation, without opening the chest or using a heart-lung machine. Other access routes exist when the leg arteries are not suitable. The choice between TAVI and surgical valve replacement is made by a multidisciplinary team (the "heart team") of cardiologists, cardiac surgeons and anaesthetists. It takes into account age, surgical risk, the anatomy of the valve and arteries, other illnesses and the patient's wishes. TAVI is now offered primarily to older patients and to those at high surgical risk. At Clinique Pasteur Tunis, patient selection is based on this joint discussion, and the procedure is performed in a latest-generation catheterisation laboratory, with a cardiac surgery team and cardiac intensive care on site.