TAVI (Transcatheter Aortic Valve Implantation)

What is the heart and how does it work?

The heart is a muscle inside your chest, which has valves and four chambers inside. The heart pumps blood around your body to your vital organs. It’s important that your organs receive blood filled with oxygen to keep them alive and working well.

What is a TAVI?

A transcatheter aortic valve implantation is a day surgery procedure that can be performed under general anaesthetic (completely asleep) or only with sedation. After numbing the area, an incision is cut into the groin, where a thin tube (catheter) is passed into the femoral artery. This is a blood vessel that leads directly to the heart. The doctor will pass the catheter through the femoral artery to the heart. Using special imaging methods to see the heart, the doctor might expand the catheter like a balloon, to open the calcified and tight aortic valve; but this is not always needed.

The doctor will then pass a prosthetic valve into place where the diseased aortic valve is. The prosthetic valves are made from metal mesh and either cow or pig tissue. The valve will either expand itself or be expanded with another small balloon to fit snugly into place. Once this is finished, the catheter is removed from your groin and the incision is stitched closed.

What is aortic stenosis?

In your heart, an important structure known as the aortic valve can become scarred and covered in calcium deposits over many years as you age. As a result, blood cannot be pumped out of your heart and around your body effectively. This is what we call aortic stenosis. This may be worsened by conditions like high blood pressure, high cholesterol, diabetes and previous heart infections.

You might experience symptoms of aortic stenosis including shortness of breath, chest pain, dizziness and tiredness.

Why do I need a TAVI?

Your doctor may recommend this procedure if you have severe aortic stenosis, and are not a candidate for open heart surgery. TAVI is a much less invasive procedure than an open surgery to replace your aortic valve, and will still improve the function of your heart and provide relief from symptoms.

What are the alternatives?

Other options for the treatment of severe aortic stenosis include surgical aortic valve replacement (open heart surgery) or medical management.

You have most likely been offered TAVI because you are a high risk surgical patient. This means your risk of dying during open heart surgery outweighs the potential benefit of the surgery. This might be due to old age, or medical conditions like lung disease, heart failure, diabetes or cancer.

Medical management is another option which doesn’t involve surgery at all. It will not fix the damaged aortic valve and is not considered a cure, however it can provide some relief from symptoms, slightly improve heart function and make you more comfortable.

What are the risks of a TAVI?

  • Infection of the cut in your groin
  • Infection of the prosthetic heart valve
  • Bleeding or damage to your blood vessels
  • Abnormal rhythms of the heart, which may require pacemaker insertion
  • Leakage of blood around the sides of the valve causing backflow (aortic regurgitation)
  • Stroke
  • Kidney injury
  • Blocked coronary artery
  • Death

What do I need to do after the procedure?

You will likely stay in hospital for a few days after your TAVI to keep an eye on your recovery. Depending on your medical conditions and previous medications, you may be asked to take a blood thinning medication (like aspirin). You will have to take this medication long-term.

Once you have been discharged from hospital, it can take weeks to feel back to normal. It’s important to avoid heavy lifting or straining for a couple of weeks after the procedure. You won’t be allowed to drive for four weeks. It’s important to continue gently exercising as much as you can tolerate – walks are a great daily activity. You are also strongly encouraged to get involved with cardiac rehabilitation after your procedure as it has been shown to significantly improve survival.