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Transcatheter Aortic Valve Implantation (TAVI)

 

Aortic stenosis is a disease where the aortic valve has calcium deposits building up on the valve leaflets causing them to be narrowed, rigid and obstructing the blood flow from the heart to the aorta and onward to the rest of the body. This condition makes your heart work harder to pump blood to your body.

The aortic valve lies between the left ventricle and the aorta and functions by allowing blood to flow in one direction without obstruction.

Traditionally, major open surgery was the only option to replace the aortic valve. Nowadays, the preferred treatment is often the minimally invasive approach called TAVI/TAVR.

 

 

A TAVI is the implantation of an aortic valve without removing the diseased valve, performed under local anaesthesia.

The TAVI approach is X-ray guided and delivers a fully expandable replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the normal function of the valve.

Before the Procedure

Fasting: Please stop eating six hours before your procedure time. You may continue to drink clear fluids (water, weak BLACK tea and weak BLACK coffee) up to two hours before your procedure time. Do not consume milk as this is considered food. You may take your regular medications with sips of water.

Allergies: Please tell Intra staff at the time of booking if you have any medication allergies, food allergies or previous reactions to X-ray contrast (dye).

Diabetes: If you are a diabetic, please tell Intra staff at the time of booking. You may need to discuss your insulin/diabetes medication dose with your cardiologist.

Anticoagulants (blood thinner): If you are taking a blood thinner (e.g. Warfarin, Rivaroxaban, Dabigatran, please advise Intra staff at the time of booking. Your cardiologist will advise you if you need to stop this medication temporarily for a few days prior to procedure (usually 3 days).

Medications: Please continue these unless advised otherwise by your cardiologist.

During the Procedure

Performed under conscious sedation and local anaesthetic, a TAVI is usually completed within 1-2 hours.

Your groin and wrist will be cleaned with an antiseptic solution and you will then be covered with a large sterile drape. The groin (and sometimes wrist) will be completely numbed with local anaesthetic. This will sting for about thirty seconds. You may feel pressure but you should not feel any pain for the duration of the procedure. If at any time you feel pain or are uncomfortable, please let your doctor know and more local anaesthetic or pain relief can be given.

At least 3 small hollow tubes (sheaths) will be inserted into the vein and arteries of the groin and sometimes the artery of the wrist. These are access sites for the valve and for catheters (thin flexible long tubes) used for taking images and pressure measurement of the heart.

In preparation for the new valve, a balloon aortic valvuloplasty (BAV) may be performed to stretch and dilate the aortic valve and make room for the new one. Your heart will be stimulated to beat very fast using the pacing cable during each balloon inflation. At this stage you will be comfortable.

Pressure measurements with the new valve functioning will be recorded. Another BAV may be performed to ensure the new valve is sitting well and has no leaks.

Final X-ray images and safety checks will be done before the catheters and sheaths are removed. At this stage the sedation will start to wear off and you will become more awake.

 

After the Procedure and going home

You will be transferred to the cardiac investigation unit (CIU), Mercy Hospital to recover and be monitored. If appropriate you will be discharged 1-2 days after the procedure.

Someone must drive you home or accompany you in a taxi.

Due to the sedation, you may feel lethargic afterwards with reduced concentration. There is also a risk of bleeding from the puncture sites (wrist and/or groin). For this reason after your procedure:

  • Do not do any activity requiring strength, concentration, or full alertness for the rest of the day.
  • Do not make any legal decisions or sign legal documents for 24 hours.
  • Do not drive for 4 weeks
  • Please arrange for someone to be at home with you on the day of discharge and overnight for support.

What are the risks?

As with any procedure, there are potential risks involved. Your cardiologist will explain the procedure, discuss possible risks and answer any questions you may have. You will then be asked to sign the consent form. This will occur either at an earlier appointment, or on the day of your procedure.