TAVI stands for transcatheter aortic valve implantation. This is a minimally invasive
catheter-based procedure for patients with aortic stenosis. Aortic stenosis is an area
of one of the main heart valves that can result in breathlessness, chest pain, or even dizziness
and loss of consciousness. TAVI is performed by introducing a valve into one of the blood
vessels usually at the top of the leg in a collapsed form. The valve is advanced over
a guide wire into the heart and is expanded in the narrowed valve to replace its function.
This can be done either with the balloon or using a self-expanding mechanism. TAVI is
suitable for patients with aortic stenosis who are either at high or intermediate risk
for open-heart surgery. We will normally discuss with you what we think is the best option
for you and for most patients your case will be discussed at a multidisciplinary heart
team meeting in order to evaluate which we think is the most appropriate option for you.
Before you have your TAVI procedure, you will require a number of investigations. This will
include an ECG to assess the heart rhythm, an echocardiogram, which is an ultrasound of
the heart which allows us to assess the valve function as well as the pumping function of
the heart. You will also require a CT scan which is a specialist scan which allows us
to assess the heart valve and measure its size and determine which size of valve and
which type of valve is best to implant. The CT scanner also will look at the blood vessels
and allow us to determine whether we can introduce the valve from the leg or whether an alternative
access is going to be better. The CT scan also looks at the coronary arteries and may
well be that you will require coronary angiography if the CT scan suggests that there are significant
coronary disease. You will be admitted the day before the procedure and we will tell
you whether you need to stop any medications prior to coming into hospital. The TAVI procedure
itself is performed in the cardiac catheter lab; which is an x-ray lab which allows us
to see the valve as it is introduced into the body. The TAVI procedure generally lasts
between an hour and an hour and a half and is performed under local anaesthetic with
you awake or with a small amount of sedation if you are feeling anxious. We will put some
local anaesthetic into the skin at the top of your leg and we will introduce tubes into
the blood vessels and it's through this which we will introduce the valve and implant it
into your heart. You shouldn't feel anything as it passes through your body. Though, some
patients do have a little bit of discomfort, but this is generally short-lived. After the
procedure you will be returned to the ward and you should be able to mobilise within
about four to six hours. We often aim to get patients home the next day but sometimes it takes a little bit longer.
Like any heart operation, TAVI does have some
risks and some of these can include serious complications. Death or stroke can occur in
approximately 2% to 3% of patients. In addition, there is a risk of injury to the blood vessel
where we introduce the valve at the top of the leg. This can result either in bruising
which occasionally may be excessive or more extensive bleeding which may require further
intervention or even surgery to repair the blood vessel at the top of your leg. In about
five to ten percent of patients, we need to implant a permanent pacemaker as the wiring
of the heart which is very close to your aortic valve can be damaged during the TAVI procedure.
The pacemaker implantation is a relatively straightforward local-anaesthetic procedure
that can generally be performed on the same day or the next day after the TAVI procedure.
TAVI valves have a known durability that may be between 5 and 15 years. That means, your
valve may need to be replaced at some point in the future. Currently we don't know for
sure how long these valves will last, but the vast majority of patients do not require
any further intervention. A small number of patients will have a leak around the valve
which we call a paravalvular leak. On occasions, this may require additional intervention either
with further stretching of the valve or even implantation of another valve.
The main benefit of TAVI is that the recovery time is much shorter than for open-heart surgery.
Generally, we would expect you to be up and about after the procedure within four to six
hours with the potential to be discharged the next day. You may feel a bit sore after
the procedure, but we would expect you to return to normal activities within a very
short period of time and hope that you would have left symptoms and improved exercise tolerance
almost immediately. We will follow you up in about four to six weeks’ time with repeat
ECG and echocardiogram to assess the TAVI valve function. Though, if you have any symptoms
in the meantime, we would be happy to see you earlier to evaluate that.