Qu'est-ce que le remplacement de la valve aortique par transcathéter : aperçu, avantages et résultats attendus
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### What is Transcatheter Aortic Valve Replacement (TAVR)?
Transcatheter Aortic Valve Replacement (TAVR) is a medical technology that offers a minimally invasive approach to replacing a faulty aortic valve with an artificial one. The procedure involves the insertion of a replacement valve through a catheter or a small incision in the chest. TAVR is most commonly used to treat aortic stenosis, a condition in which the aortic valve does not open properly and has a reduced diameter, leading to insufficient blood flow.
With the development of TAVR technology, it is now possible to replace the aortic valve without requiring the patient to undergo open-heart surgery. The procedure is less invasive, meaning it requires less risk and allows patients to recover faster with fewer complications. TAVR is widely used to treat aortic stenosis in patients who are at high risk for open-heart surgery, such as those with weakened heart muscles, weakened lungs, diabetes, obesity, or renal failure. The procedure can also be used in people with an artificial heart valve, known as a bioprosthetic valve, who need to be re-operated on.
### Overview of Transcatheter Aortic Valve Replacement (TAVR)
TAVR relies on advances in medical imaging and catheter technology to stop or slow valve leakage. It is a procedure that is done using a catheter (a thin tube) to deliver an artificial valve into the body from the groin area. Prior to the procedure, a specialized imaging technique such as echocardiography or computed tomography (CT) is used to take images of the patient’s anatomy. Once these images have been taken, the physician or surgeon can use an imaging system, such as fluoroscopy, to guide the catheter through the patient’s blood vessels.
Once the catheter is in the correct position, an artificial aortic valve is inserted into the body through the catheter. The patient is then kept still while the medical team monitors the pressure and flow of the new valve. The doctor then decides when to remove the catheter and artificial valve and place the new valve in the correct position.
### Benefits of Transcatheter Aortic Valve Replacement (TAVR)
Transcatheter Aortic Valve Replacement (TAVR) offers many benefits to patients when compared to traditional open-heart surgery. The procedure is often less invasive, meaning it requires less risk and allows patients to recover faster with fewer complications. TAVR is also safer for many patients, particularly those who are at high risk of complications with open-heart surgery. In addition, TAVR may reduce the hospitalization time and speed up the patient’s recovery.
Furthermore, advances in imaging technology have led to better accuracy when positioning the catheter in the body. This has helped to reduce the procedure’s morbidity and mortality rates. TAVR can also reduce the need for medications for high blood pressure and diabetes, as well as the need to undergo other invasive procedures following the surgery.
### Expected Results of Transcatheter Aortic Valve Replacement (TAVR)
The expected results of TAVR are usually improved heart function and increased patient wellbeing. In most cases, patients with aortic stenosis experience symptoms such as breathlessness, chest pain, dizziness, and fatigue. After the procedure, these symptoms are typically reduced and patients often experience overall improved health.
It is important to note that while TAVR is highly effective, complications may still occur. Most complications are minor and can often be attributed to the individual patient’s health or the procedure itself. In rare cases, more serious complications may arise, such as stroke, organ damage, or death.
The patient’s doctor can evaluate the risks associated with the procedure prior to the procedure. In addition, patients can take several steps to reduce their risk of complications following TAVR, such as quitting smoking and following any exercise or diet instructions given to them by their doctor.
### Conclusion
Transcatheter Aortic Valve Replacement (TAVR) is a medical technology that offers a minimally invasive approach to replacing a faulty aortic valve with an artificial one. The procedure is often less invasive, meaning it requires less risk and allows patients to recover faster with fewer complications. TAVR may reduce the need for medications for high blood pressure and diabetes, as well as the need to undergo other invasive procedures following the surgery. The expected results of TAVR are usually improved heart function and increased patient wellbeing. Potential complications of TAVR include stroke, organ damage, and death, but these risks can be greatly reduced by taking precautions such as quitting smoking and following exercise and diet instructions. TAVR is an effective procedure, and patients should discuss the risks and benefits of this procedure with their doctor prior to undergoing the procedure.
Transcatheter Aortic Valve Replacement (TAVR) is a medical technology that offers a minimally invasive approach to replacing a faulty aortic valve with an artificial one. The procedure involves the insertion of a replacement valve through a catheter or a small incision in the chest. TAVR is most commonly used to treat aortic stenosis, a condition in which the aortic valve does not open properly and has a reduced diameter, leading to insufficient blood flow.
With the development of TAVR technology, it is now possible to replace the aortic valve without requiring the patient to undergo open-heart surgery. The procedure is less invasive, meaning it requires less risk and allows patients to recover faster with fewer complications. TAVR is widely used to treat aortic stenosis in patients who are at high risk for open-heart surgery, such as those with weakened heart muscles, weakened lungs, diabetes, obesity, or renal failure. The procedure can also be used in people with an artificial heart valve, known as a bioprosthetic valve, who need to be re-operated on.
### Overview of Transcatheter Aortic Valve Replacement (TAVR)
TAVR relies on advances in medical imaging and catheter technology to stop or slow valve leakage. It is a procedure that is done using a catheter (a thin tube) to deliver an artificial valve into the body from the groin area. Prior to the procedure, a specialized imaging technique such as echocardiography or computed tomography (CT) is used to take images of the patient’s anatomy. Once these images have been taken, the physician or surgeon can use an imaging system, such as fluoroscopy, to guide the catheter through the patient’s blood vessels.
Once the catheter is in the correct position, an artificial aortic valve is inserted into the body through the catheter. The patient is then kept still while the medical team monitors the pressure and flow of the new valve. The doctor then decides when to remove the catheter and artificial valve and place the new valve in the correct position.
### Benefits of Transcatheter Aortic Valve Replacement (TAVR)
Transcatheter Aortic Valve Replacement (TAVR) offers many benefits to patients when compared to traditional open-heart surgery. The procedure is often less invasive, meaning it requires less risk and allows patients to recover faster with fewer complications. TAVR is also safer for many patients, particularly those who are at high risk of complications with open-heart surgery. In addition, TAVR may reduce the hospitalization time and speed up the patient’s recovery.
Furthermore, advances in imaging technology have led to better accuracy when positioning the catheter in the body. This has helped to reduce the procedure’s morbidity and mortality rates. TAVR can also reduce the need for medications for high blood pressure and diabetes, as well as the need to undergo other invasive procedures following the surgery.
### Expected Results of Transcatheter Aortic Valve Replacement (TAVR)
The expected results of TAVR are usually improved heart function and increased patient wellbeing. In most cases, patients with aortic stenosis experience symptoms such as breathlessness, chest pain, dizziness, and fatigue. After the procedure, these symptoms are typically reduced and patients often experience overall improved health.
It is important to note that while TAVR is highly effective, complications may still occur. Most complications are minor and can often be attributed to the individual patient’s health or the procedure itself. In rare cases, more serious complications may arise, such as stroke, organ damage, or death.
The patient’s doctor can evaluate the risks associated with the procedure prior to the procedure. In addition, patients can take several steps to reduce their risk of complications following TAVR, such as quitting smoking and following any exercise or diet instructions given to them by their doctor.
### Conclusion
Transcatheter Aortic Valve Replacement (TAVR) is a medical technology that offers a minimally invasive approach to replacing a faulty aortic valve with an artificial one. The procedure is often less invasive, meaning it requires less risk and allows patients to recover faster with fewer complications. TAVR may reduce the need for medications for high blood pressure and diabetes, as well as the need to undergo other invasive procedures following the surgery. The expected results of TAVR are usually improved heart function and increased patient wellbeing. Potential complications of TAVR include stroke, organ damage, and death, but these risks can be greatly reduced by taking precautions such as quitting smoking and following exercise and diet instructions. TAVR is an effective procedure, and patients should discuss the risks and benefits of this procedure with their doctor prior to undergoing the procedure.
Présentation et avantages
Le remplacement valvulaire aortique transcathéter (TAVR) est une procédure utilisée pour traiter une valve aortique rétrécie. La valve aortique est l'une des quatre valves du cœur humain. Il comporte trois feuillets. Ces feuillets sont ouverts pour permettre au sang de pousser vers l'avant lorsque le ventricule gauche se contracte. Ils se ferment entre les battements de cœur pour empêcher le sang de refluer.
La valve aortique peut se rétrécir, s'épaissir et devenir moins flexible à mesure qu'une personne vieillit. Lorsque cela se produit, la valve ne s'ouvre pas complètement à chaque fois que le ventricule se contracte. En conséquence, le cœur est obligé de travailler plus fort pour faire passer le sang. Au fil du temps, cela peut fatiguer le cœur. Cela se traduit par un certain nombre de symptômes. Ceux-ci comprennent des douleurs thoraciques, un essoufflement et des étourdissements. Lorsqu'elle n'est pas traitée rapidement, la condition peut progresser. Cela peut provoquer la coeur à l'échec. Il s'agit d'une condition potentiellement mortelle.
La condition est traitée en remplaçant la valve aortique malade. Cette procédure est souvent réalisée par chirurgie à cœur ouvert. Cette méthode nécessite une incision dans la cavité thoracique pour accéder et remplacer la valve malade. Le TAVR est une option à la chirurgie à cœur ouvert. Elle est moins invasive et ne nécessite que de petites incisions. Cependant, tous les patients n'y ont pas droit. Les patients éligibles à cette procédure sont ceux qui ne sont pas assez bien pour supporter une chirurgie à cœur ouvert. Cela peut également être une option pour les patients atteints de certaines conditions médicales.
Qui devrait subir et résultats attendus
De nombreux patients avec une valve aortique rétrécie préfèrent la TAVR à la chirurgie à cœur ouvert. En effet, il minimise les nombreux risques de la chirurgie à cœur ouvert. Cependant, le TAVR n'est une option que pour ceux qui répondent à certains critères. Il s'agit notamment de patients extrêmement âgés (80 ans et plus) et de ceux qui ne sont pas assez forts physiquement pour subir une chirurgie à cœur ouvert.
Avant même que le TAVI ne soit recommandé, les patients sont évalués par une équipe multidisciplinaire de spécialistes afin de déterminer leur admissibilité.
Il est important de noter que tous les patients présentant une valvule aortique sténosée ne doivent pas nécessairement subir une intervention chirurgicale. Ceux qui ont des cas légers à modérés et qui ne présentent pas de symptômes de la maladie peuvent ne pas nécessiter de traitement. La progression de la maladie peut être retardée dans la plupart des cas en adoptant un mode de vie sain.
The procedure can restore normal blood flow to the heart. Because of this, patients are relieved of their symptoms. Their quality of life is also expected to improve significantly. In addition, their risk of heart failure will be greatly minimised.
Comment se déroule la procédure ?
Il existe deux méthodes d'exécution du TAVR. Leur principale différence est l'emplacement de l'incision. L'incision peut être pratiquée au niveau de l'aine (approche transfémorale) ou de la poitrine (approche transapicale).
Transfémoral signifie passer par l'artère fémorale. Cette artère est accessible par l'aine. Dans cette procédure, le chirurgien crée une ouverture dans l'aine et insère une gaine d'introduction dans l'artère fémorale. Un fil de guidage flexible est ensuite inséré à travers la gaine et avancé jusqu'à l'aorte et le ventricule gauche. Le fil de guidage est ensuite utilisé pour faire passer un cathéter à travers la valve aortique. Ce cathéter a un petit ballon à son extrémité. Une fois gonflé, ce ballon peut élargir la valve aortique. Un autre cathéter est ensuite utilisé pour placer la valve de remplacement. Un stent est utilisé pour soutenir la valve.
La deuxième méthode est appelée approche transapicale. Il nécessite une incision dans la poitrine (entre les côtes) pour accéder à la partie la plus basse du cœur. Il suit ensuite les mêmes étapes expliquées ci-dessus. Les deux approches sont réalisées sous anesthésie générale. Les deux utilisent également un type spécial de rayons X que les chirurgiens utilisent comme guide tout au long de la procédure. Pendant la chirurgie, l'équipe chirurgicale du patient surveille de près sa fonction et son rythme cardiaques. Tout changement de la fonction cardiaque est géré au besoin pendant la procédure. Après la chirurgie, les incisions sont fermées avec des points de suture. Les patients reçoivent ensuite des antibiotiques pour prévenir l'infection.
Les patients sont ensuite transférés à l'unité de soins intensifs de l'hôpital. Ils sont étroitement surveillés pour d'éventuelles complications. De nombreux patients restent à l'hôpital entre trois et cinq jours.
Il est important que les patients adoptent un mode de vie sain après la chirurgie. Il leur est conseillé de surveiller ce qu'ils mangent. Ils doivent également faire régulièrement certains exercices approuvés par leur médecin. Il leur est également déconseillé de fumer et de boire trop d'alcool. Il est également important qu'ils maintiennent un poids santé.
Risques potentiels et complications
Bien que moins invasif que opération à coeur ouvert, TAVR a des risques de complications. Ceux-ci comprennent des dommages aux vaisseaux sanguins et des saignements graves. La liste des risques possibles comprend également les accidents vasculaires cérébraux et les crises cardiaques. Les patients peuvent également développer des arythmies, des infections et des maladies rénales. Dans les cas les plus graves, il peut entraîner la mort.
Les références:
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Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease : Un rapport de l'American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Le Journal de chirurgie thoracique et cardiovasculaire. 2014;148:e1.
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Mack MJ, et al. 5-year outcomes of transcatheter aortic valve replacement ou surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial. The Lancet. 2015;385:2477.
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Very informative article! #ValveReplacement
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