In NMIC LRC of the Russian Ministry of Health operation TAVI

2024: Conducting Operation TAVI

Operation TAVI was carried out at the National Medical Research Center of the LRC of the Ministry of Health of Russia. The center announced this on October 1, 2024.

Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgery performed on patients with aortic valve stenosis. The patient who was given TAVI has already been transferred from the intensive care unit to the usual ward and is on the mend.

source = National Medical Research Center of the Ministry of Health of Russia

The peculiarity of the operation is that to access the heart, the surgeon does not make a single incision on the patient's chest, all manipulations are carried out through a catheter inserted into a blood vessel. The main advantage of this technology is its low invasiveness: unlike open prosthetics of the aortic valve, a large incision is not made here and the aorta is not removed.

We performed transcatheter aortic valve implantation with a single access to the femoral artery. After that, the patient was given a special catheter, through which a contrast drug was introduced. The endovascular aortic valve was implanted under the control of the contrast drug administration. To perform the operation, the puncture sites of the femoral arteries are previously stitched with special endovascular devices. That is, it turns out that there is access to the artery, but there is no large cut as in the public domain surgical. In this case, the incision remains very small, about one and a half centimeters, - said the head of the vascular center of the National Medical Research Center of the LRC Ministry of Health Russia Alexander Pokatilov.

The complexity of the operation lies in reaching the desired position in which the valve should be implanted. Much depends on the device itself. Specifically, the Acurate Neo 2 valve manufactured by Boston Scientific was used in this case.

According to Alexander Pokatilov, a multidisciplinary approach plays a large role in the success of the operation, when close contact is established between the surgeon and his team. The surgeon implants a valve, the assistant helps him in this matter, the anesthesiologist "imposes" the desired heart rhythm on the electrocardiostimulator, in connection with which a high frequency of heart contractions is achieved - from 160 to 300 beats per minute. Without the anesthesiologist with whom the surgeon interacts, it is impossible to achieve the success of the procedure. Also important are US diagnostics specialists who conduct an echofunctional study and help determine the function of the valve.

We can say that valve implantation is only the "tip of the iceberg," since surgery is the final stage. Before it, you need to prepare and plan well: choose the correct valve size, calculate how it will stand, determine whether balloon dilation will be performed. The entire course of treatment includes careful preoperative planning, the selection of intervention tools, the postoperative period, that is, the observation of heart function in order to assess the operation of the valve and the presence of leaks that can pass through the valve. If leaks are present, balloon dilation is required to optimize the valve with the left ventricular outlet wall and press. In our case, a good result was achieved, and this did not need to be done, - said Alexander Pokatilov.

The TAVI operation differs from the traditional one in that after it the patient does not need to be in the hospital for about a month. The intervention itself lasts about one and a half to two hours, after which the patient is sent to intensive care. The day after the operation, he is transferred to a regular ward and can get up.