What is TAVI?
The aortic valve is the door through which blood leaves the heart to the rest of the body. With age and certain risk factors, 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 an 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 heart surgery, but is now also used for many patients at intermediate and lower risk, particularly older patients.
What happens on the day?
TAVI is done in a catheterisation laboratory, most often under sedation with local anaesthetic in the groin, although general anaesthesia is sometimes used. A catheter is passed up an artery from the groin to the heart and the new valve is guided into position under X-ray. 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.
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 one to three days. Expect some bruising and tenderness in the groin. Most patients feel substantially better, although complete recovery may take several weeks.
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 requiring a stent or surgical repair, stroke, kidney strain from the contrast dye, heart attack, a tear of the heart or an artery, infection of the valve and rarely, the need for emergency open heart surgery. Long term, the valve can become narrowed or leak again after many years, requiring a second TAVI procedure.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.