Transapical is an approach to Transcatheter Aortic Valve Replacement (TAVR). Transcatheter Aortic Valve Replacement is a form of surgery that replaces the aortic valve through a catheter rather than open-heart surgery. There are three approaches to TAVR: transfemoral approach, transaortic approach, and the transapical approach. The difference between this approach and the others is the placement of the catheter. The transfemoral approach places the catheter through the artery in the thigh. The transaortic approach places the catheter through the aorta and goes from the top. The transapical approach goes from below and the places the catheter through the apex of the heart. This approach requires a smaller incision and allows for a quicker recovery.
The aortic valve is an important valve in the heart. It rests at the point the aorta meets the left ventricle. When the blood pressure in the ventricle gets to a certain level, it lets the aortic valve know it is time to open. The aortic valve is susceptible to disease which leads to either aortic valve stenosis or aortic valve regurgitation. Aortic valve stenosis is primarily fixed through transcatheter aortic valve replacement. When the aortic valve narrows, it prevents the aorta from getting all the necessary blood it needs to send to the rest of the body. Aortic stenosis may be minor at first, so symptoms are not noticeable. When stenosis worsens, you will begin to feel lightheaded and experience a lot of fatigue, as a result of the body not getting enough blood and oxygen.
As stated earlier, the transapical approach for TAVR goes through the apex of the heart, the lowest part of the heart. A surgeon makes an incision between the rib cage in the chest cavity. This incision is fairly small because instead of trying to get a human hand through, the surgeon is only getting a catheter through. A surgeon places a sheath through the incision. A sheath is a hollow tube that the catheter will go through to get to the aortic valve. A balloon catheter goes through the sheath to the aortic valve. The surgeon expands the balloon and opens the narrow aortic valve. Once opened, the catheter is removed, and a replacement valve is added to the catheter. The catheter is inserted back into the sheath and expanded once again to put the new valve in place. Once the new valve is in place, it begins to work like the old aortic valve. The surgeon does not remove the old valve. Instead, the new valve pushes the old one out of the way. The leaflets of the old valve rest against the aortic wall but also help to hold the new valve in place.
Although the transapical approach for TAVR sounds good, it is not for everyone. It is up to your surgeon to decide which method is best for you. Most of the time, this method is used in the most severe cases. When aortic stenosis is severe, the doctors want to use an approach that is least invasive; this helps the body recover faster. If the patient is at high risk for open-heart surgery, TAVR is the best way to fix the problem. Some patients may also be sick, meaning they have blood-related issues or an illness like pneumonia. High-risk patients that require surgery need a method of surgery that requires the least amount of trauma and little recovery time. The small incision made heals very quickly. Once the surgery is over, the doctor monitors the new aortic valve. Hospital stay is very short, and the doctor will want you to get back on your feet as soon as possible. With the new valve, your body can function better. You may see an instant decrease in your symptoms. As the body adjusts to the new valve, you will continue to progress.
The new aortic valve works just as well as the old one. Prognosis is very good. The valve lasts a long time. There are risks involved in the procedure. With any surgery, there is a risk of infection as well as blood loss. The risks are greatly minimized due to the size of the incision as well as the shorter surgery time. The valve that replaces the old one is mechanical. There is a possibility that the new valve will have to be replaced if it malfunctions.
The transapical approach of TAVR is minimally invasive and great for those who are at a high risk. If you are a candidate for TAVR, it is up to the physician to decide which approach is best for you. The transapical approach does cut through the wall of the heart, but the incision is so small that it does not cause any other problems. You may be fearful of heart surgery, but you shouldn’t be. Aortic valve replacement is necessary, especially when you are experiencing symptoms. Replacing the aortic valve can improve your health instantly.
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