The most common heart valve defect is a narrowing of the aortic valve (aortic valve stenosis). The aortic valve is the heart valve between the left ventricle and the aorta. With aortic valve stenosis, the left ventricle has to pump harder to pump blood into the systemic circulation, as the opening of the narrowed heart valve becomes increasingly smaller. This results in a reduction in blood volume in the systemic circulation despite an increase in the wall thickness of the left ventricle. If the heart valve is not replaced, the pumping capacity of the left ventricle is reduced. The symptoms of high-grade aortic valve stenosis increase considerably due to the restricted pumping function.
At the beginning of aortic valve stenosis, symptoms are only mild. If high-grade aortic valve stenosis has existed for a long time, the symptoms are pronounced.
It is very important to take the first symptoms very seriously, as aortic valve stenosis can be replaced by TAVI using a cardiac catheter or by surgery. There is no medication that can eliminate aortic valve stenosis. Symptoms of aortic valve stenosis include poor performance, shortness of breath (dyspnoea), chest pain (angina pectoris), dizziness and even fainting or, in the worst case, sudden cardiac death.

Cardiac ultrasound with normally opening aortic valve. Cardiac ultrasound is standard in the diagnosis of heart valve defects. It can also be used to detect the pumping function of the left ventricle and other heart valve defects.

Until 2005, heart valve replacement was only possible through surgery in combination with a heart-lung machine in cardiac arrest under general anaesthetic. Since then, heart valve replacement (TAVI) using catheter technology has developed rapidly and is now the standard treatment for high-grade aortic valve stenosis. The latest data show that the occurrence of complications (kidney failure, pneumonia, atrial fibrillation, etc.) is significantly less frequent and, conversely, survival is significantly better when patients receive a new heart valve using the TAVI technique than when these patients undergo cardiac surgery as was previously the case.
Due to the rapid development of TAVI heart valves for the treatment of aortic stenosis, almost all patients can now be treated via an access to the inguinal vessel. If the inguinal vessels are blocked on both sides, open surgery can be avoided via a small surgical access at the apex of the heart. A few cases still have to be operated on today, as very large heart valves are not yet available for the TAVI technique. Which patient benefits best from which heart valve is discussed by the heart team consisting of heart specialists from cardiology and heart surgeons.

Catheter-guided aortic valve implantation (TAVI) via the inguinal artery does not require a general anaesthetic and is performed under local anaesthesia. This enables rapid mobilisation after the procedure, so that discharge from the cardiology department is usually possible 5 days after the procedure. Ulm University Hospital has extensive experience with the implantation of catheter-supported aortic valves. In 2007, it was the first university centre in Baden-Württemberg to introduce the TAVI technique. To date, we perform 400 TAVI procedures every year at the Department of Internal Medicine II in one of our state-of-the-art hybrid cardiac catheterisation laboratories. Image data obtained in advance can be imported into the operating theatre (image fusion) and used for the procedure. The special room air technology in the hybrid cardiac catheterisation laboratories is even designed for surgical procedures and, above all, the image quality required for inserting the heart valve under fluoroscopy is of the very latest standard.

Prior to the TAVI procedure, precise diagnostics, including computed tomography (cardiac CT), echocardiography (ultrasound) and cardiac catheterisation, are necessary to determine the best procedure for the patient and to determine the valve size and type. All TAVI heart valves are biological heart valves. After insertion of this heart valve, blood thinning with e.g. Marcumar is not necessary due to the heart valve. Atrial fibrillation is often a concomitant disease. In this case, the atrial fibrillation means that blood thinning must be used in the further course of the procedure. The latest generation of TAVI heart valves are available, which can be repositioned after insertion. This allows an optimal treatment result to be achieved.

The procedures are carried out in the hybrid cardiac catheterisation laboratories of the Department of Internal Medicine II by Medical Director Prof. Dr Wolfgang Rottbauer in cooperation with cardiac surgery colleagues. The Department of Internal Medicine II at Ulm University Hospital is a leader in Germany in the performance of aortic valve replacement using the TAVI technique and trains doctors from other clinics in training programmes set up specifically for this purpose.
Illustration: Visualisation of the aorta (aortography) after insertion of a heart valve of the latest generation using the TAVI technique. You can see an optimal result after TAVI. The constriction is immediately eliminated by the insertion of the new heart valve and the left ventricle can once again eject sufficient blood into the systemic circulation via the new heart valve. (film)

If you suffer from a narrowed aortic valve (aortic valve stenosis) and have questions as to whether a heart valve replacement (e.g. TAVI) is necessary for you or whether you are suitable for it, you can make an appointment at our outpatient clinic at any time.