What is TAVI?
The aortic valve is the door through which blood leaves the heart for the rest of the body. With age it can become stiff and calcified so that the door barely opens, a condition called aortic stenosis, which causes breathlessness, chest tightness, dizziness and blackouts, and eventually heart failure. Transcatheter aortic valve implantation, or TAVI, replaces that valve without opening the chest or stopping the heart. A new valve, folded inside a catheter, is passed up the artery from the groin and expanded inside the old valve, pushing the diseased leaflets aside and taking over their function immediately.
Why is it done?
Severe aortic stenosis that causes symptoms is dangerous, and no medication can open the valve; without treatment the outlook is poor. TAVI relieves the obstruction, and most patients notice that they breathe more easily within days to weeks. It was first used for patients considered too high a risk for open surgery, and is now also used for many patients at intermediate and lower risk, particularly older patients. The choice between TAVI and surgical valve replacement is made by a heart team, including cardiologists and cardiac surgeons, after a CT scan, an ultrasound of the heart and an angiogram, taking your age, anatomy and other conditions into account.
What happens on the day?
You are admitted fasting, usually the day before or on the morning of the procedure. TAVI is done in a catheterisation laboratory or hybrid theatre, most often under sedation with local anaesthetic in the groin, although general anaesthesia is sometimes used. A catheter is passed up the artery from the groin to the heart, a temporary pacing wire is placed for safety, and the new valve is guided into position under X-ray and ultrasound. It is then expanded, either with a balloon or by self-expanding, and starts working straight away. Measurements and pictures confirm that it is well seated and not leaking before the catheters are removed and the groin artery is closed. The procedure typically takes one to two hours.
What to expect afterwards
You are monitored closely for a day, often in a high care unit, mainly to watch the heart rhythm and the groin site. You lie flat for several hours, and most patients are up and walking the next day and home within two to four days. Expect bruising and tenderness in the groin, and avoid heavy lifting and strenuous activity for one to two weeks. You will take antiplatelet or anticoagulant medication as prescribed, and you should tell any dentist or doctor that you have a prosthetic valve, taking antibiotic cover before dental work. Follow-up includes an ultrasound of the heart before discharge and again in the rooms, and lifelong yearly review of the valve. Most patients feel substantially better; cardiac rehabilitation helps you regain strength.
Possible complications
TAVI has become a routine procedure, but it is major treatment in mostly older patients and the risks are real. Common: bruising or bleeding at the groin, and a need for blood transfusion in some patients. An important and fairly frequent complication is disturbance of the heart's electrical conduction, which means around one in ten patients needs a permanent pacemaker afterwards. Other possible problems are a small leak of blood around the new valve, injury to the artery in the groin or abdomen requiring repair, stroke, kidney strain from the contrast dye, heart attack, a tear of the heart or the main artery, infection of the valve, and, rarely, the need for emergency open surgery or death. Long term, the valve can become narrowed or leak again after many years. Your heart team will discuss your individual risk in detail before you consent.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.