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Transcatheter Aortic Valve Implant (TAVI)

TAVI is short for trans-catheter aortic valve implantation, and is a way of improving how your heart works without having to remove your own narrowed valve. It involves putting a stent with an artificial valve into your heart.

The valve is made up of three ‘leaflets’ (made of material derived from cows) which control blood flow. The valve is inside a metal cage called a stent, which holds the new valve in position.

You do not need open heart surgery to have this procedure. Instead, the valve is inserted into the heart through a thin tube (known as a catheter) which is put into the body through a small cut in either your groin or your chest.

The procedure takes up to two hours and is carried out under local or general anaesthetic. Because this is a less invasive procedure with a shorter anaesthetic than open-heart surgery, it means that a person considered too high a risk for open heart surgery may face a lower risk with this newer procedure.

You will be reviewed by a specialist Heart Team consisting of Cardiologists, Heart Surgeons, Anaesthetists and Radiologists who will propose the best option for dealing with your heart valve disease based on investigations including:

  • Detailed echocardiogram
  • Specialised CT (Commuted Tomography) Scan
  • Coronary angiogram

This should be discussed with you to determine with you what your best options are.

How is the procedure performed?

The procedure is usually performed in a catheter laboratory or hybrid theatre suite where there is specialised radiology equipment to help with the procedure

There are 2 main ways that the valve can be implanted:

  1. Transfemoral (Leg artery): This is performed through a small cut into one of your groin arteries and is performed usually under local anaesthesia.
  2. Transapical (Apex of the heart): This is performed through a small incision in your chest wall and is performed under general anaesthesia.

Alternative less common approaches may be used depending on the patient’s anatomy – Subclavian (Arm artery), Ministernotomy (Breastbone), Minithoracotomy (Between the ribs) or Transcaval (Leg Vein)

A pacing wire is initially placed into a vein in your leg. This wire acts as a pacemaker, allowing the team to temporarily speed up your heart at key points in the procedure. This means that less blood is passing through your aortic valve, enabling to ensure that the artificial valve is positioned correctly.

The TAVI valve is placed by making a small cut in your groin and/or chest. Sheaths are placed in your groin and wrists. Through these sheaths, a fine tube (catheter) is placed to your heart. A deflated balloon is passed through the catheter. When it reaches your aortic valve, the balloon is inflted, widening the valve.

Before your artificial valve can be implanted, it is carefully crimped (compressed) and mounted onto the balloon and then placed through the sheath to your heart. Once it is in place, your artificial valve is expanded by the balloon so that it fits across your existing valve, holding it open permanently. This procedure will improve how well your heart works without you having to have your own diseased aortic valve removed.

When you wake up you may have puncture sites in your groin from the pacing wire and tubes (sheaths) used to get the images we require for positioning the valve. Any incisions are sutured closed.


What happens after the procedure?

Initially you will be transferred to the Recovery Unit in theatres so that you can be closely monitored. You will then be transferred to either the coronary care unit (CCU) or back to the ward.

During your stay in hospital, you will also have the following tests:

  • A chest x-ray.
  • Routine blood tests to check how well your kidneys and liver are working, to make sure you do not have a blood infection, to check that your blood can clot properly, and to make sure you have enough haemoglobin, which carries oxygen around in your blood.
  • An electrocardiogram (ECG).
  • A trans-thoracic echocardiogram. You will have this just before you leave hospital after your procedure. It involves having an ultrasound probe placed on your chest so it can record images of your heart.

You are likely to be in hospital for approximately 2-3 days after your procedure.