Replacing a Damaged Heart Valve Without Opening the Chest

• There are several main types of cancer treatment, including surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, stem cell transplant, and image-guided procedures such as RFA and TACE.
• Most patients receive a combination of treatments rather than just one, with the plan personalized to cancer type, stage, location, age, general health, and treatment goals.
• The main difference in chemotherapy vs radiation therapy is reach. Chemotherapy is systemic and travels through the bloodstream, while radiation therapy is targeted at a specific area.
• Side effects depend on the treatment type, but most are temporary and can be managed with supportive care from a specialist team.
• Early detection through structured cancer screening greatly improves the chance of cure and often allows for less extensive treatment.
• Nakornthon Cancer Center provides comprehensive, multidisciplinary cancer care in Bangkok, with tumor board reviews, modern equipment, and individualized treatment plans.

Cancer remains the leading cause of death in Thailand, affecting people of all ages but most commonly diagnosed in adults over 50. The good news is that cancer care has changed dramatically. Today's types of cancer treatment are more precise, more personalized, and often more effective than the options available even a decade ago. A cancer diagnosis no longer means a single fixed pathway. Most patients now receive a tailored combination of therapies designed to give them the best possible outcome.

This guide walks through the main cancer treatment methods explained in plain language, how doctors decide between them, and what to expect at each stage. It is written for patients and families seeking clarity before, during, or after a diagnosis.

What Is TAVR (TAVI)?

TAVR stands for Transcatheter Aortic Valve Replacement, and is also known as TAVI (Transcatheter Aortic Valve Implantation) in Europe and Asia. The terms refer to the same procedure. It is a form of minimally invasive heart valve surgery in which a new tissue valve is delivered to the heart through a catheter, usually inserted into the femoral artery in the groin, and expanded inside the diseased aortic valve. Once in place, the new valve immediately takes over the function of the old one, restoring normal blood flow without removing the original valve.

TAVR is used to treat severe symptomatic aortic stenosis in patients who are at intermediate, high, or prohibitive risk for open-heart surgery. International guidelines now also support TAVR for many low-risk patients, depending on age, anatomy, and life expectancy.

> Return to Contents

Aortic Stenosis Symptoms and Why It Is Dangerous

Aortic stenosis occurs when the aortic valve becomes stiff and narrowed, often due to calcium buildup with age. As the valve opening shrinks, the heart must work harder to push blood out to the body. If untreated, severe aortic stenosis can lead to heart failure, dangerous heart rhythms, fainting, and even sudden death, sometimes in patients who previously felt only mild symptoms.

Common Symptoms of Aortic Stenosis

• Chest pain or pressure, especially during physical activity or exertion.
• Shortness of breath, particularly when active or lying flat.
• Fatigue and reduced exercise tolerance, often described as feeling easily tired.
• Dizziness or fainting (syncope), especially during activity.
• Swollen ankles, feet, or abdomen from fluid retention in advanced cases.

Because symptoms can develop gradually and feel like normal aging, many patients delay seeking care. Once symptoms appear, however, the risk of serious complications rises sharply, and timely evaluation by a cardiologist becomes important.

> Return to Contents

TAVR vs Open-Heart Surgery (SAVR) Key Differences

Both TAVR and Surgical Aortic Valve Replacement (SAVR) aim to treat severe aortic stenosis, but they differ in approach, incision size, anesthesia, and recovery time.

> Return to Contents

Who is suitable for TAVI treatment for valvular stenosis?

TAVR is generally considered for patients with severe, symptomatic aortic stenosis who are at intermediate, high, or prohibitive risk for open-heart surgery. The decision is made by a multidisciplinary heart team after detailed imaging and assessment. Common candidates include:

• Older adults, particularly those aged 75 and over, where surgical risk and recovery time are concerns.
• Patients with multiple medical conditions such as lung disease, kidney disease, or frailty, that increase surgical risk.
• Patients who have had previous heart surgery, where a repeat sternotomy would be high risk.
• Patients with anatomy suitable for catheter delivery, confirmed by CT and echocardiography imaging.
• Patients with severe symptomatic aortic stenosis who have responded poorly to medication alone.

Patients with active metastatic cancer or other conditions that limit life expectancy may not benefit from TAVR, and the heart team will discuss alternative care options in those situations.

> Return to Contents

Advantages of TAVI treatment for heart valve stenosis

Reduce risks and complications arising from surgery.

• Minimal incision, no chest wound.
• Less pain, faster recovery
• No anesthesia required.
• Reduce the rate of recurrence.
• The outcome of the treatment is as good as a standard heart surgery.
• It is beneficial for the elderly or people with underlying medical conditions who may not be able to withstand long hours of major surgery.

> Return to Contents

Preparing for TAVR

1. The patient will undergo a detailed physical examination and health history, and the severity of valvular stenosis will be assessed, such as blood tests and x-rays.
2. Assess the readiness of the body for TAVI treatment.
3. Your doctor will ask about any medications, supplements, vitamins, or herbs you are currently taking. Patients should prepare such medicines with them.
4. If wearing dentures or braces, inform your doctor first.
5. On the morning of treatment, the patient should clean their body and change into a new set of clothes. Do not apply lipstick, nail paint, and powder on the body.
6. Remove jewelry, dentures, and leave valuables with relatives.
7. For patients' safety, they will have their blood pressure and oxygen measured in the blood and ECG examination, etc.

> Return to Contents

How Does TAVR Work? Step by Step

TAVR is performed in a specialized hybrid operating room equipped with advanced imaging. The procedure typically takes 2 to 3 hours and follows four main steps

Step 1. Local Anesthesia and Access

You are positioned on the procedure table and connected to monitors for heart rhythm, blood pressure, and oxygen levels. Most TAVR procedures use local anesthesia with conscious sedation, although light general anesthesia may be used in some cases. The skin in the groin is cleaned and numbed, and a small incision or puncture is made to access the femoral artery.

Step 2. Catheter Insertio

A thin hollow tube called a sheath is inserted into the femoral artery and guided up to the aortic valve using X-ray and ultrasound imaging. If the femoral arteries are not suitable, alternative access routes such as the transapical approach (through the tip of the heart) or transaortic approach (through a small chest incision) may be used.

Step 3. Valve Deployment

The replacement valve, mounted on a balloon or within a self-expanding stent, is advanced through the catheter to the diseased aortic valve. Once correctly positioned, the new valve is expanded, pressing the old valve leaflets aside and immediately taking over normal function.

Step 4. Catheter Removal and Closure

After confirming the new valve is functioning well with imaging and pressure measurements, the catheter system is withdrawn. The access site is closed with special closure devices or sutures, and a pressure dressing is applied. You are then transferred to a monitored recovery area for close observation.

> Return to Contents

Biplane DSA Precision Imaging During TAVR

Biplane Digital Subtraction Angiography (Biplane DSA) uses two X-ray cameras positioned at different angles to capture highly detailed, real-time images of the heart and blood vessels during TAVR. This dual-plane imaging gives the heart team a near three-dimensional view of the catheter and valve, allowing precise positioning, reduced contrast dye use, and improved overall safety. Biplane DSA is one of the key technologies that has made minimally invasive valve replacement faster, safer, and more accurate.

> Return to Contents

Recovery After TAVR and What to Expect

Recovery after TAVR is typically faster than after open-heart surgery, but you will still need close follow-up, prescribed medicines, and a gradual return to activity guided by your cardiologist.

For the first 3 months after TAVR, patients are usually prescribed anticoagulant or antiplatelet medication and asked to avoid heavy exertion. After this period, most are able to return to normal daily life, often with significantly improved symptoms.

> Return to Contents

Possible risks

Possible risks and little or no occurrence from inserting artificial heart valves using catheter techniques, including:

• Bleeding or a blood clot caused by bleeding and accumulation under the skin or infection at the catheter insertion site.
• damaged blood vessels
• kidney problems from the excretion of contrast material from the body
• Thrombosis constricts the blood vessels in the brain
• myocardial infarction
• arrhythmias
• Prosthetic heart valve slipping out of position
• loss of life

> Return to Contents

TAVR vs Other Heart Procedures

TAVR is designed specifically to treat severe aortic valve narrowing. It is different from other common heart procedures such as coronary artery bypass surgery, which is used to bypass blocked heart arteries, and balloon angioplasty (PCI), which uses a balloon and stent to open narrowed coronary arteries supplying the heart muscle. Some patients have both valve disease and coronary artery disease, and may require a combination of treatments. For example, balloon angioplasty for blocked arteries followed by TAVR for the aortic valve, depending on the overall heart condition.

> Return to Contents

TAVR at Nakornthon Hospital Heart Center

At Nakornthon Hospital Heart Center, TAVR is performed by a multidisciplinary heart team that includes interventional cardiologists, cardiac surgeons, anesthesiologists, and imaging specialists. The procedure takes place in a dedicated hybrid operating room equipped with advanced biplane DSA imaging, which supports precise valve placement and safer minimally invasive valve replacement.

Patients receive comprehensive pre-procedure assessment, individualized treatment planning, and structured follow-up designed to help them return to daily life with improved symptoms and heart function. Our Heart Center operates around the clock, with cardiac specialists and emergency cardiac services available 24 hours a day.

If you or a loved one has been diagnosed with severe aortic stenosis or wants a second opinion on heart valve treatment options, our team is ready to help. Make an Appointment with a cardiologist to discuss whether TAVR is right for you.

Make an Appointment or find a doctor for a free online consultation

Make an appointment with a fertility specialist today, or contact us for an initial consultation to discuss your options.

• Heart Center Hours: Open Daily, Monday to Sunday, 07:00 to 20:00. Heart Center Fl.1
• Facebook Fanpage: Nakornthon Hospital - International Patient
• LINE Official: @nakornthoninter
• Tel: 02-450-9999 ext. 1074 to 1075 (available 24 hours for cardiac emergencies)

> Return to Contents