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The woman had been suffering from progressive shortness of breath for several years, even from mild physical exertion. In recent months, he has had difficulty walking less than a hundred meters due to shortness of breath.
“Most aortic valve stenoses are caused by calcification of the aortic valve. This significantly increases the risk of ischemic stroke during aortic valve surgery. Based on the patient’s studies, it was decided to introduce protective filters into the carotid arteries prior to the TAVI procedure to prevent migration of calcium particles into the cerebral arteries.
After a successful TAVI procedure, these filters are removed. They detected calcium particles up to 3 millimeters in size that could have caused an embolic ischemic stroke. Protective filters should be used during these procedures for all patients at high risk of ischemic stroke, ”said the head of the Department of Interventional Cardiology at the Kaunas Cardiology Clinic, Prof. Ramūnas Unikas.
Patients with aortic valve stenosis who undergo an aortic valve implant through a catheter are typically older and have severe comorbidities, according to the news release. The latter increase the risk of routine surgical treatment of the aortic valve by opening the chest and can cause additional difficulties under general anesthesia.
“Often, patients older than 80 years do not want more serious treatments because they think that the risk of surgery outweighs its benefits in later life,” says prof. R. Unikas. – However, in 2011 we implanted an aortic valve through a catheter in an 88-year-old patient who still visits at least once a year for screening. By improving our professional knowledge and applying the latest treatment methods, we guarantee maximum safety for all patients treated at the Kaunas clinics. “
According to Kasparas Briedis, a cardiologist at the Department of Interventional Cardiology of the Cardiology Clinic, who performed the first aortic valve implantation procedure using a catheter (TAVI) without general anesthesia, the most important task was to familiarize the entire team with the operation and prepare to possible complications.
“It is also very important to familiarize the patient with the procedures performed during the operation and the sensations expected. We plan to perform this complex procedure only under conditions of local anesthesia: the patient remains conscious throughout the procedure, so it is necessary to constantly communicate with him during the operation, assessing the state of health.
By being able to perform this operation without anesthesia, we can directly assess the neurological status of the patient due to a possible stroke, the first hours of which are vital for treatment.
By not applying general anesthesia, we also facilitate the recovery of the patient after surgery, this is especially important in old age ”, said K. Briedis. The doctor has learned the latest treatment techniques and gained experience through long-term internships in the United Kingdom, Italy, Switzerland, Germany, and the United States.
According to K. Briedis, the number of people with aortic valve stenosis is growing significantly in Europe due to the increase in the average life expectancy of the population. Untreated severe aortic valve stenosis can lead to heart failure or even sudden death.
“With clinical symptoms of severe aortic stenosis and no aortic valve surgery, the chances of survival are slim. Statistics show that less than half of patients survive 2 years, “said cardiologist K. Briedis.
According to the Head of the Cardiac Defects Sector of the Kaunas Cardiology Clinic, Assoc. Vaida Mizarienė, aortic valve stenosis is the most common heart disease, characterized by a progressive course. The most common cause of aortic valve stenosis is degenerative valve calcification, where calcium gradually accumulates in the valve sails over the years. Congenital bipolar aortic valve or rheumatism can also cause stenosis.
“It is important to know that heart murmurs, progressive shortness of breath during exercise, chest pain or tightness in the chest, swelling of the legs, dizziness, fainting, fatigue during exercise are the first signs of stricture of the aortic valve, “says doc. V. Mizariene.
A multidisciplinary team of specialists from the Kaunas clinics ensured the smooth course of the complex procedure. The first protective filters were implanted by a cardiologist prof. Ramūnas Unikas and cardiologist Kasparas Briedis.
In the second stage of the procedure, the first successful operation of the aortic valve through the catheter (TAVI), without the patient under general anesthesia, ensured by cardiologist Kasparas Briedis, cardiologist Kristina Morkūnaitė, medical resuscitator anesthesiologist doc. Tadas Lenkutis, anesthesia and intensive care nurse Aldona Mackevičienė, surgical nurses Jolita Volungevičienė, Daiva Pažereckaitė, and radiology technologists Rūta Gaubienė and Egidijus Lysenko.
Currently, the incidence of aortic stenosis among the population older than 65 years exceeds 2 percent. Approximately 4.9 million patients with aortic valve stenosis are registered in Europe. According to experts, there are 400 to 500 patients in Lithuania who can undergo TAVI each year. Catheter procedures at the Kaunas clinics are not new: In 2019, the hospital performed the 100th TAVI procedure.
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