Dr Malik lectures again! This time at CSI-CASPIAN 2023. Dr Malik was invited to give a talk on how to avoid the complication of a permanent Pacemaker after a transcatheter aortic valve procedure (TAVI) for aortic stenosis. Read the takeout's below.
Aortic stenosis is a narrowing of the outflow valve of the heart. If this gets narrowed it can cause symptoms of sudden death, chest pain, breathlessness and blackouts. If you have severe symptomatic AS (SSAS), and don’t have treatment, the risk in the next few years of death or heart failure is 50%.
If you have severe symptomatic Aortic stenosis (SSAS), you will need that valve treated. The two treatments are surgical Aortic Valve Replacement (sAVR), and Transcatheter Aortic Valve Intervention (TAVI). TAVI is less invasive and has faster recovery.
There is a 5% risk of major complications with TAVI. A pacemaker is sometimes also needed- that is not really a complication, but an add on procedure:
Death- 1-2%
Stroke 1-2%
Vascular injury or heart attack 1-2%
A permanent pacemaker (PPM) is implanted under the skin with wires that do to the heart. It takes over the function of the hearts own electrical bales if they are not working.
I spoke about how to predict that a PPM will be needed and how to reduce the risk of a pacemaker being needed. Some key takeout's include:
Patient factors:
If you are older, your risk is higher
Valve factors:
A more calcified valve, with calcium just below the valve also, and only a small gap below the valve till the heart muscle starts- makes it more likely
ECG:
If your start with weak electrical cables in the heart that makes it worse.
Procedure:
The procedure must be done well to avoid a pacemaker- even then, a pacemaker can be needed in between 5-20% of cases.
Valve make and model, valve size, the height of deployment inside the original valve- all make a difference.
Dr Malik has a world-wide reputation in TAVI and lectures internationally on the topic. Contact us and we will make an appointment for you to see him.
To find out more about the event, visit their website.
Dr Iqbal Malik is a consultant cardiologist, specialising in coronary artery disease and structural heart disease including PFO, ASD and the TAVI procedure.
