what's a TAVI?

RAGING HYPOTHETICAL:
--Hypotensive, elderly gentleman presents to your ED, records show he's had a TAVI

--You nod your head with a reassurring look, then run to google...

--Next time you won't need to - because you read this post.

WHAT'S A TAVI?

Transcatheter Aortic-Valve Implantation (TAVI) for patients with severe aortic stenosis who are not candidates for surgery.

What it looks like:

How it is placed: (so cool and worth watching)
The implantation procedure involves accessing a femoral artery, performing balloon valvuloplasty, then advancing the device across the native valve. During rapid right ventricular pacing, a balloon is inflated to deploy the valve and the frame.

Video animation: http://youtu.be/_eiI6S62zOs

and http://www.nejm.org/doi/full/10.1056/NEJMoa1008232 (NEJM)

Evidence it works:

At one year, the rate of death from any cause was 30% with TAVI vs. 50.7% with standard treatment (balloon aortic valvuloplasty and or medical therapy)

Not so good: TAVI had a higher incidence of strokes and major vascular complications compared to standard treatment, however this was included in rate of death.

Now you know :)

Submitted by S. Morris.

Reference(s): Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607.; http://medgadget.com/2010/09/transcatheter_aorticvalve_implantation_tavi_reduces_mortality_rate_compared_to_standard_therapy.html (image)