Until recently, patients with valvular heart disease underwent classic cardiac surgery with opening the chest and cutting the sternum, and older patients who did not qualify for such surgery simply died. Today, thanks to highly specialized treatments such as TAVI, Valve in Ring or Valve in Valve, they gain a chance for a quick recovery.
In statistics, valvular heart disease is the third most popular cardiological disease in Poland and Europe, after hypertension and ischemic heart disease. Statistically, the most common acquired heart disease isaortic stenosis (AS), characteristic of the aging population, which affects approximately 5% of the population. patients over 75 years of age. In patients with severe AS, pharmacotherapy does not improve prognosis, and surgical implantation of an artificial, mechanical, or biological valve is the treatment of choice. Unfortunately, the perioperative mortality in the group of elderly patients with multiple comorbidities causes almost 1/3 of patients - in Poland it is probably about 2,000. patients - not qualified for surgical treatment.
TAVI saves the hearts of elderly patients
Thanks to the transcatheter aortic valve implantation (TAVI) treatment, introduced a few years ago, the possibilities of treating AS patients requiring surgical treatment have expanded significantly. Elderly patients, usually over 70 years of age, are eligible for the TAVI procedure, also due to the fact that the aortic valves used for these procedures are bioprostheses made of bovine or porcine pericardium. One of the required criteria is the presence of a tight acquired aortic stenosis and a high risk of surgical treatment of a heart defect, usually due to comorbidities.
Valvular heart disease is the third, after hypertension and ischemic heart disease, the most popular cardiological disease in Poland and Europe.
However, each decision on the preferred method of treatment for acquired AS is made jointly by the cardiologist and the cardiac surgeon as part of cooperation in the heart team.
In the worldTAVI has been performed for over a dozen years. In Poland, the first such procedure took place in Kraków in 2008, and the next ones were carried out in Zabrze, Katowice and Warsaw. In 2015, in our country, interventional cardiologists and cardiac surgeons from 20 centers performed almost 650 valve implantations using the TAVI method. It is statistically 17 treatments per 1 million inhabitants, while the European average is 60 - 70 treatments per 1 million inhabitants. Transcatheter aortic valve implantation is a very important procedure from the point of view of interventional cardiology, in many cases saving the lives of patients with acquired valvular heart disease. Until the end of 2014, it was a highly specialized procedure, financed by the Ministry of He alth, and from 2015 the payer is the National He alth Fund.
Modern techniques of treating valve defects
In interventional cardiology, there are more and more new, highly specialized hybrid procedures, which, due to the degree of complexity, are only able to be performed by a few operators in Poland. One such modern method is Valve in Ring, which involves placing the TAVI valve in the ring after surgical correction of the mitral valve. This procedure is dedicated to patients who have biological valves in the classic cardiac approach, and who need to replace the valve with a new one due to damage and dysfunction of the existing valve.
Due to financial reasons, not all patients in Poland can use the new methods of treatment. They are dedicated mainly to the elderly and where there are indications. Then the National He alth Fund will refund them.
Another variant of the TAVI procedure is Valve in Valve, in free translation: valve to valve. It consists in the transcatheter implantation of a new valve into a damaged aortic or mitral (mitral) biopthesis previously implanted by a cardiac surgeon. Thanks to the modern method of transcatheter repair of dysfunctional valves, the patient gains another 10-15 years of good quality of life.
In addition, there are devices for percutaneous correction of the function of a regurgitated mitral valve that are used in patients at high risk of cardiac surgery. Unfortunately, these procedures are performed in Poland even less than TAVI, and there are many patients waiting for them. In addition to treating aortic and mitral valve defects, interventional cardiologists are now directing their steps towards effective "repair" of two more valves - the pulmonary valve and the tricuspid valve. According to the representatives of the environment, it will be soonThis "valvular revolution" will ensure that they will be able to repair all heart valves in an increasing number of patients without having to open the chest.