Transcatheter aortic valve implant (TAVI)

Your heart is a muscle which pumps blood to your lungs and around the rest of your body. There are four valves in your heart.

Normally, these valves open to let blood flow through or out of your heart, and then shut to keep it from flowing backwards.

If your valve is diseased or damaged this can affect the flow of blood to your heart in two ways.

1 If the valve does not open fully, it will obstruct the flow of blood. This is called valve stenosis.

2 If the valve does not close properly, it will allow blood to leak backwards, in the wrong direction. This is called valve incompetence or regurgitation.

The symptoms of valvular disease vary depending on which valve is affected, they may include:

• Tiredness or breathlessness when exercising.
• Palpitations or feeling like your heart is racing.
• Chest pains (angina) because there is not enough blood.
• Flowing through the coronary arteries, which supply the heart muscle with blood.
• Spells of dizziness and fainting, this can happen if the obstruction is severe.

The back pressure (the effect of blood flowing backwards) can also cause shortness of breath and swelling of the ankles and legs.

For some people one way of treating their heart problem is to insert a new aortic valve percutaneously (through an artery via the skin). A catheter is a thin hollow tube. Access to the heart will be through a catheter in the artery in the wrist, and a larger catheter in the artery on the groin.

The new aortic valve is passed through the catheter in your groin. Once the catheter reaches your heart, it is positioned in the opening of your aortic valve. The new valve either expands by itself or is expanded using a balloon. The cardiologist will close the puncture site with a device that seals your artery.

TAVI procedures are performed under local anaesthetic with or without sedation. Your consultant will discuss the best option with you.

For some patients, the approach from the artery in the leg is not possible and the valve may need to be implanted from the artery around the shoulder (Transaxillary TAVI) or through a vein in the leg (Transcaval TAVI). Use of these access points may require general anaesthetic.

Your new valve will be made out of either Porcine (Pig) or Bovine (Cow) pericardium which is cut into shape and then sewn into a metallic frame which can be squeezed into a small catheter. We use several different valve types, depending on your anatomy. Some valves are put in with a balloon, others are self-expanding and some can be mechanically deployed.

The TAVI procedure has a success rate of more than 98%. It can help reduce your symptoms of shortness of breath, chest pain, dizziness and fainting.

However, as with any heart procedure there are risks, and they vary from person to person. This will be discussed by your cardiologist when you come for your appointment at the clinic and again when you come to sign the consent form.

Some patients may need a Permanent Pacemaker after the TAVI as the new valve can squash the electrical conduction system of the heart. If this is the case for you, we will usually put in a pacemaker during the first couple of days following your TAVI.

You will need to have a number of tests to see if the TAVI procedure is the right one for you. These tests may include an echocardiogram (ultrasound scan of the heart) and a CT scan.

Prior to the procedure, you will be contacted by our structural heart nurse specialist to attend a pre-admission clinic. You may also be approached about participating in a clinical trial.

The structural heart nurse will go through your medications during the pre-admission clinic. If you are taking a warfarin/ apixaban/rivaroxiban/edoxaban/dabigatran, you must STOP these 3 days prior to the procedure.

You may be asked to come in the evening before or on the day of the procedure. The ward team will take blood samples and do an electrocardiogram (ECG) on admission. You will not be able to eat or drink for six hours before your procedure.

The procedure lasts approximately one and a half hours. We will close the puncture site in your groin with a device that seals the artery. The nurse looking after you will regularly inspect your groin, check your blood pressure and check the pulses in your feet.

We will observe your heart rhythm on a cardiac monitor overnight. If all is well, you will be able to sit up on return to ward and get out of bed that evening or the following morning.

While you are in the Cardiac Care Unit (CCU) it may not always be possible to care for you with other patients who are the same sex as you because we will be using specialised equipment as part of your care. However we provide substantial screening around your bed, to preserve your privacy and dignity. There is limited space in the ward, so we suggest you do not bring too many things with you into hospital.

Before you go home we will review your medication. You may need to take Aspirin to start with and we will review this in clinic

If there have not been any problems, you should be able to go home the day after the procedure.

We recommend that you have someone who can stay with you for up to 2 days following discharge to help with recovery. You may need support over the next 1-2 weeks while recuperating.

Recovery at home will continue at different rates for each person. It may take a few weeks or months to feel the maximum benefits following the TAVI procedure.

If you expect problems organising your own transport home, then please contact us prior to admission as soon as you can.