THV approaches (Click on the Link

  • Transfemoral approach
  • Transapical approach

  • Transcatheter Heart Valve (THV)

    Aortic Stenosis

    Blood is pumped through the chambers of the heart, aided by four heart valves. The valves open and close to let the blood flow in only one direction. When the aortic valve opens, oxygen-rich blood flows from the left ventricle to the aorta.

    Aortic Stenosis is a condition in which the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, obstructing blood flow from the heart into the aorta onward to the rest of the body. When the aortic valve is obstructed, the heart needs to work harder to pump blood to the body.

    Eventually, the heart muscle becomes thicker because it has to pump harder due to the obstruction. In addition, the heart can pump only a limited amount of blood - and eventually can't provide the increase in blood flow needed for day to day activities.

    Aortic Stenosis


          •   Shortness of breath
          •   Fainting or near fainting
          •   Heart palpitations
          •   Chest pain
          •   Fatigue
          •   Dizziness
          •   Heart murmur

    Test And Diagnoses Doctors will perform several tests to confirm the diagnosis and determine the severity of the problem.

          •   Echocardiogram: A probe is placed on the chest and images of the heart are recorded.
          •   CT Scan: A heart-imaging test with or without intravenous (IV) contrast (dye) to determine if either            fatty or calcium deposits (plaques) have built up in the coronary or femoral (groin) arteries
          •   Cardiac Cathereterization: Involves inserting a catheter into a blood vessel in the leg or arm, and            guiding it to the heart with the aid of a special x-ray machine. Contrast dye is injected through the            catheter to obtain information about the heart, blood vessels, and femoral arteries.

    Treatment Options

    After reviewing the pre-procedure tests, you and the physicians will determine the best treatment option for you.

    1. Medications
    2. Balloon Valvuloplasty (BAV)
       (These two options may alleviate symptoms but do not cure aortic stenosis permanently)
    3. Balloon Valvuloplasty (BAV)Traditional Aortic Valve Replacement Surge
    4. Transcatheter Aortic Valve Clinical Trial (PARTNER TRIAL)

    he Edwards SAPIEN transcatheter heart valve, developed by Edwards Lifesciences, gives patients who are considered high-risk or non-operable an alternative to traditional aortic valve replacement surgery.


    Why Transcatheter?

    The new heart valve is implanted without open-heart surgery, using minimally invasive techniques. First, the Edwards Sapien transcatheter heart valve is loaded onto a balloon delivery catheter. Then it is threaded through the patient’s circulatory system from the leg (transfemoral approach) or inserted between the ribs (transapical approach) directly into the heart and postioned to replace the patient’s diseased valve. Both procedures are performed on a “beating heart,” without the need for cadiopulmonary bypass and its associated risks.




    Who is a possible candidate for the procedure?

          •   Critical aortic stenosis
          •   Advanced age
          •   Previous sternotomy for cardiac procedures
          •   Previous radiation to the chest
          •   Porcelain (heavy calcification) of the aorta
          •   Frailty or debility
          •   A Society of Thoracic Surgeons (STS) predicted risk of mortality of conventional surgery >10%
          •   Cerebral or peripheral vascular disease, renal insufficiency or other significant co-morbidities
          •   Turned down for conventional valve replacement surgery



    Created by Nima Nia for BME 240 Spring 2009