Transfemoral Approach

When you hear the word transfemoral, you may initially think of the femur. The femur is the thigh bone, the strongest and longest bone in the body. The transfemoral approach is a method of surgery for Transcatheter Aortic Valve Replacement (TAVR). What does the femur have to do with the aortic valve? Well in this method, cardiothoracic surgeons replace the aortic valve by going through the thigh. They do not cut into the thigh bone but use the artery in the thigh.   This type of surgery is minimally invasive and leads to a faster recovery.

transfemoral approach heart disease surgery top10md mdThe thigh is a very strong part of the body. It contains a lot of muscle as well as the biggest bone in the body. If you workout, you will notice it takes a lot more weight to build your thigh muscles than it does other parts of the body. The muscles and bone of the thigh require oxygen and blood to work properly. An artery supplies the oxygen and blood. The artery in the thigh branches off from the aorta. The aorta starts at the heart but travels down to the thoracic region and branches off down to the legs. If the aortic valve does not work properly, it will limit blood supply to the rest of the body. Through the femoral approach for TAVR, a replacement valve is put in place without having to go through the chest.

Transfemoral approach primarily fixes aortic valve stenosis. Stenosis is the narrowing of the aortic valve. When the valve gets narrow, it will not allow enough blood to flow into the aorta. The heart will begin to pump harder, and you will start feeling symptoms. Since the artery in the leg branches from the aorta, the aortic valve can be fixed through an incision in the thigh. This approach is minimally invasive. It only takes one small cut in the thigh, and the surgeon places the catheter inside the artery. This method is easier than open heart surgery.

The Procedure

An incision is first made in the thigh.  The surgeon places a sheath inside the artery, which helps guide the catheter. The catheter used is a balloon catheter. As you read through the procedure, you will understand why a balloon catheter is used. The catheter travels to the aortic valve. Once it reaches the valve, the balloon catheter expands to open the aortic valve. Now the aortic valve is wide enough for a new valve. The balloon catheter is removed, and the new valve is placed on the balloon catheter. The catheter is inserted back into the artery. The catheter travels through the cardiovascular system back up to the aortic valve. It expands once again, but this time, to put the new valve in place. The old valve is not removed; the new valve pushes the leaflets of the old valve up against the artery wall. These leaflets help keep the new valve in place. Once the new valve is secure, it begins to work.

Candidates

Everyone is not a candidate for the femoral approach of TAVR. Those who are considered for this type of surgery usually have severe aortic stenosis. The severity of the problem makes doctors consider a less traumatic approach. Open-heart surgery is very risky. If you are too high- risk for open heart surgery, then you will also be considered. You may have other illnesses besides the aortic valve stenosis. If you are sick, doctors will try to avoid open heart surgery as well. The best part of this approach is that it only takes one cut. It does not require any punctures to the heart like other approaches do.

Benefits

transfemoral approach heart disease surgery top10md mdThe transfemoral approach for TAVR has its benefits. In open heart surgery, the chest cavity is cut open. This procedure leads to a long and uncomfortable recovery process. One tiny incision in the leg heals very quickly. Your pain and level of discomfort are minimal. With the valve working automatically, doctors will just monitor your heart rate and probably do another echocardiogram to make sure everything sounds good. Hospital stay is short, and you can go back to your daily routine. Follow-up visits are necessary to keep an eye on the new heart valve. Now with the new aortic valve, you should feel much better. You will probably notice an increase in energy and your breathing should return to normal. The dizziness and lightheadedness should go away.

The transfemoral approach for Transcatheter aortic valve replacement is a great way to fix the problem without having to undergo a traumatic surgery. Who would have thought you would be able to replace a heart valve through your leg. Everyone is not a candidate for this method of surgery. The more severe the case is, the more likely a cardiothoracic surgeon will use this method to replace your aortic valve. If the surgeon does not think this method is best for you, they will choose a method that is. If you are having aortic valve problems, ask your physician about TAVR. It can be a great benefit to you.

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