Interventional cardiology has made impressive progress in recent years in developing techniques to repair and replace heart valves without requiring open surgery as in the past. The greatest progress has been made in the last twenty years in the treatment of degenerative aortic valve stenosis, which is a progressive fatal condition very common in older people. Severe ‘aortic stenosis’ can occur in one in seven people over the age of 75, can cause symptoms that significantly limit daily activities, and can only be treated by replacing the diseased aortic valve.

The modern and most indicated method of treating aortic stenosis is today the transcatheter implantation of a new prosthetic valve (TAVI: transcatheter valve implantation). This method started 20 years ago as an alternative to surgery in patients with a very high surgical risk and has today proven to be equal to surgical valve replacement in even low surgical risk patients. The result of this development is that it is recommended by international guidelines as the first choice of treatment in patients aged >75 years regardless of surgical risk. The reasons are that the effectiveness and safety of the less invasive TAVI is comparable to that of surgery, while the rehabilitation of patients is naturally much easier compared to surgery, which is of particular importance especially for older patients. Patients are mobilized faster and leave the hospital sooner.

The TAVI method has evolved into an operation that minimally affects the patient, since today it is carried out in most cases with local anesthesia or light intoxication, that is, with the patient awake and without general anesthesia.

Traumatic or unpleasant interventions are avoided (urinary catheter, tracheal intubation, placement of central venous catheters, transesophageal echocardiography) and access to the vessels to advance the catheter with the valve is done exclusively percutaneously without surgical incision and exposure of the vessel. In particular, with the use of ultrasound guidance, the percutaneous puncture of the vessels is performed with absolute success and safety. This allows immediate mobilization of patients and a short discharge from the hospital after surgery.

There is a wide variety in the types of valves used to perform TAVI, with some requiring balloon expansion, while others are operator-released and self-expand to the intended location. The operation is carried out in the hemodynamic laboratory by a specially trained interventional team with the presence of an anesthesiologist and the readiness of a cardiac and vascular surgeon.

The valves used to perform TAVI, as well as the systems with which they are advanced into the vascular network and positioned in the aorta, are constantly evolving so that it is now possible to implant them even in cases patients with difficult anatomy or stenoses of the peripheral vessels and thoracic aorta. In this way, TAVI through the femoral artery is achieved in the vast majority of patients, which is the method with the best results, and the use of other access routes, which require a surgical incision in the chest, is avoided. The choice of the appropriate valve depends on the age and the special anatomical characteristics of each patient and is thoroughly studied for the planning of the operation based on the CT angiography measurements.

In the last two years, a significant number of TAVI operations have been performed by the special interventional team at MITERA in mainly elderly patients with coexisting medical problems and a very high risk for open surgery. All operations were performed with complete success and without complications for the patients, most of whom were discharged from the hospital two days after the operation.