Welcome to London Cardiovascular Clinic See more
Dr Iqbal Malik features on the BBC's #hospital documentary See more
Dr Malik featured in #hospital, a BBC documentary filmed at the Imperial College hospitals.
He and the team performed a TAVI procedure on John, a 98 year old man. John has made a good recovery but it raised the issues of how affordable this type of care was. Dr Malik was clear that, although expensive on the day of surgery, it could save money as well as of course lives, by reducing subsequent admissions to hospital with heart failure and chest pain.
We all wish John well, and hope he makes 100!
Transcatheter Aortic Valve-Medtronic TAVI done in 2015- a short 4 minute video See more
This video is meant for patients. Only 4 minutes to see the steps of a TAVI procedure:
1. Access to the blood vessels
2. Pacing the heart if needed
3. Getting across a very narrow valve with a wire
4. Getting the valve in position- up from the leg
5. Deploying the valve
6. Assessing the result with echo and hemodynamics
It was filmed for IVCC, our Imperial Valve and Cardiovascular Course, which celebrated its 10th year in 2020.
Transcatheter Aortic Valve Invervention (TAVI or TAVR) is a recognised treatment for severe symptomatic aortic stenosis (SSAS). Without treatment, SSAS is a fatal disease. Treatment options are:
1. TAVI
2. Surgical valve replacement
3. Balloon valvuloplasty (BAV) if 1 and 2 are not possible
4. Medical therapy- this does not work!
The way we do it has changed over time. We started with general anaesthetic, surgeons in the room. often doing a formal surgical cut down on the leg artery, transoesophageal echocardiogram (TOE), formal temporary pacing wire, Repeated injections of contrast to check the position.
This case was was done in 2015. We hadalready switched to local anaesthetic, no TOE, No surgical cut down or surgeon in the room. This case used a formal temporary pacing wire (TPW) , and we did not use ultrasound to gain access to the femoral arteries, but used fluroscopy.
In 2021, we have very light sedation, ultrasound to get arterial access, no TPW, and really want to optimise results, deploying valves "high" to avoid the need for a pacemaker, and "well" to reduce any chance of a leak around the valve.
As you will see, the result in this patient was good, but could have been better. The patient has done well 6 years later, but I would have optimised the valve more with a balloon to push it to get more circular, if I was doing this case today.
We continue to learn what is acceptable and what is optimal in TAVI.
If you need to have a TAVI, contact my team at:
Web: www.londoncardiovascularclinic.co.uk
e-mail: [email protected]
Tel: +44 207 436 0669
