The heart is responsible for the circulation of oxygenated blood to various body organs. Once the heart stops pumping, other organs will be oxygen-deficient and die subsequently. Hence, the heart can be described as the sustainer of the human body.
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Some diseases affect the heart, ranging from the tetralogy of Fallot, which is common in children, to cardiomyopathies. As these diseases progress, they tend to reduce the quality of life of the patient. Some electrolyte imbalances also affect the heart, like imbalances in magnesium, calcium, and potassium. Severe hyperkalemia, for example, can cause arrhythmias, leading to a heart attack.
Some screening tests that can help in identifying cardiac disorders include echocardiography, electrocardiography, and chest X-ray. Findings like prolonged QRS complex, disappearing P wave, and amplified R wave on the electrocardiogram suggest hyperkalemia. This can help direct the management of the patient with such findings.
Treatment of heart disorders is dependent on etiology and includes medications, lifestyle changes, ablation, pacemakers, stents, and surgery. One of the surgical interventions for heart diseases is open-heart surgery. It is one of the oldest surgeries done on the heart. The first successful open-heart surgery was done by Dr. Daniel Williams on a patient on the 9th of July, 1983, in Chicago. Other surgeries done on the heart include minimally invasive surgeries like Transcatheter Aortic Valve Implantation.
TAVI surgery
Over the years, open heart surgeries were carried out for most of the corrections to be made on the heart, like heart transplants and heart valve repair, until 2005. On the 5th of January, 2005, Dr. McGinn, Jr, carried out the first minimally invasive surgery in the United States. There has been a need to check how effective these surgeries are when compared to open-heart surgeries. And, in response to this need, Professor Toff and his team carried out research in the UK.
913 patients with a mean age of 81, were randomly chosen to either have open-heart surgeries or Transcatheter Aortic Valve Implantation (TAVI) across centers that carry out these procedures in the UK. TAVI is used in the treatment of aortic stenosis that is severe and symptomatic. Using a catheter inserted into the chest, upper arm, or groin, which is moved towards the valve of the aorta, a new valve is placed over the old one. This is less invasive than open-heart surgery.
The results obtained from patients who had either TAVI or open-heart surgery were compared over one year. There was less bleeding and a faster time of recovery for patients who had TAVI. They also had higher quality of life improvement, functional capacity, and improvement of symptoms after 6 weeks of treatment. However, these patients were at higher risk of requiring pacemakers and having vascular complications.
Initially, TAVI was offered to those ineligible for open-heart surgery and those with greater operative risks. However, this study included those who were fitted for either of the procedures and had lower operative risks. The results showed that TAVI had similar outcomes to conventional surgery; hence, it is also as effective as conventional surgery. However, further observations of the research participants over a longer period, say 5 years, are needed.
Clinical significance
Invasive open-heart surgery has been a surgical procedure used in the correction of some heart disorders and comes with increased hospital stay and longer recovery time.
But this study, which has shown the similarity in the effectiveness of TAVI, has shed light on the field of medicine. Patients can now enjoy fewer hospital stays, quicker improvement of symptoms, and less bleeding. Thereby, a better improvement in quality of life.
Conclusion
Transcatheter Aortic Valve Implantation (TAVI), a procedure done to treat aortic valve stenosis, has proven to be of similar effectiveness to open-heart surgery, with additional benefits of shorter hospital stay and better quality of life improvement. Hence, increasing the range of options for patients with aortic stenosis.
References
The UK TAVI Trial Investigators. (2022). Effect of transcatheter aortic valve implantation vs surgical aortic valve replacement on all-cause mortality in patients with aortic stenosis: A randomized clinical trial. JAMA, 327(19), 1875–1887. https://doi.org/10.1001/jama.2022.5776
