Why you might need? Transcatheter Aortic Valve Intervention (TAVI)
If you are a higher risk patient, you may be suitable for a TAVI.
Extensive investigation and assessment will be performed by your Cardiologist before you are deemed suitable for this procedure.
Investigations you will need include ECG, Echocardiography, Blood Tests, Lung Function. You will be given a CT scan of the whole aorta to prepare for a TAVI procedure.
A TAVI (TAVR if you are from the USA) is used to treat a severely narrowed aortic valve (Aortic Stenosis). It is suitable for patients in need of an aortic valve replacement but is not well enough to have open heart valve surgery due to age or being a higher risk patient. Open heart surgery is still the standard form of treatment for this type of heart problem.
Aortic Stenosis can be associated with chest pain, breathlessness or even blackouts. Once symptomatic, treatment is proven to reduce the risk of death.
What is involved with a TAVI?
There are several approaches your Cardiologist can take when performing your TAVI:
- Transfemoral – a catheter is placed via your leg if your blood vessels are big enough
- Transapical – directly through the chest via a small cut and straight to your heart
- Trans-axillary – via the left or right shoulder
Whichever approach your Cardiologist takes, you will be in a special theatre (catheterisation laboratory). An anaesthetist will be present along with a large team in case of emergencies.
A catheter will be positioned with the opening of the aortic valve and a new tissue valve which will be placed into position. The new valve will either expand by itself, or is expanded by a balloon depending on which type of valve is used.
The balloon, if used, is deflated and removed along with the catheter, and the new valve sits inside your damaged valve. The position and function are checked on X-ray and echocardiography.
Normally you are awake for the procedure. You may spend the 1st day on the intensive care unit as a precaution.
You will go home a few days later. You need to take it easy for the 1st week, and are not allowed to drive (it is the Law in the UK) for 1 month.
See Dr Malik doing a TAVI in 2015 in this 17-min video (made for doctors to view); he has been doing them a long time!
TAVI is a safe procedure. However, as only patients at a higher risk get this treatment there are a number of possible complications including:
- At the vascular access site i.e. pain, bleeding, bruising
- Disruption of the normal electrical conduction system of the heart, which may mean you may need a Pacemaker
- A leak around the new aortic valve also known as a Paravalvular Leak
- Internal bleeding around the heart which may require emergency surgery
- Stroke or heart attack