Transcatheter aortic valve implantation (TAVI)
Transcatheter aortic valve implantation (TAVI) is a procedure intended for the treatment of severe symptomatic aortic stenosis - the natural narrowing of the aortic heart valve.
This narrowing of the aortic heart valve, known as aortic stenosis, can cause a gradual onset of symptoms. When mild or moderate it’s of no clinical concern. However, when this progresses to the severe range it can result in symptoms including exertional breathlessness, chest pain, or losing consciousness when sitting or standing. It can then progress into more severe episodes of syncope (fainting spells), low blood pressure, or other undesired symptoms.
Historically, the only treatment for this was an open surgical aortic valve replacement. This is still first-line therapy for the majority of patients, however, patients with signs of aortic stenosis are often in their senior years - in their seventies, eighties or nineties. This means they might also have other medical conditions or complicating factors going on, which means a significant operation like open heart surgery isn’t appropriate. The problem in this case is that untreated symptomatic severe aortic stenosis if left untreated is associated with a poor outcome.
That’s where TAVI comes in. The procedure is sometimes referred to as transcatheter aortic valve replacement (TAVR). Essentially, it involves the replacement of the aortic valve of the heart by transporting an implant through the blood vessels - a less invasive method than open heart surgical alternatives.
Firstly, I'd spend a good part of our initial appointment explaining what the concerns are about your condition and its potential treatments, what the investigations are for and why we do them, and what the resultant action will be depending on their outcome.
Before embarking on any procedure, we'll spend some time exploring a few concepts. Firstly, why it is that we'd do this procedure as opposed to an alternative. That’s important to clarify, especially if you’re worried or were expecting a different course of action.
We’ll talk about what the benefits are from a valve implant, and how they might improve your quality of life and long-term outcome. We’ll also explore what the risks are, both in general and specifically for your condition. TAVI might be the right choice for you, but I’ll always go through what the other alternatives are, so we have addressed all of the possibilities.
We’ll cover everything else including the ‘if's, 'but's, 'what if's and 'when's, so there are no surprises, and you always know what to expect further along the journey.
If we agree on transcatheter aortic valve implantation, the first thing we’d do would perform further tests to understand the condition of your heart, including a CT scan and heart scan. Additionally we shall perform some bloods tests and lung assessments to aid in procedural planning and to assess risk.
On the day of the procedure, you should not eat or drink for a minimum of 6 hours prior to procedure time. Following admission, routine observations will be taken, and I shall meet you to talk through any final concerns and ensure that you are still happy to proceed (consent). You will be then taken to the operating room and after some final checks we’ll commence.
As mentioned, TAVI is a minimally invasive procedure compared to open heart surgeries. It normally takes an hour or two to complete, and is usually done with anaesthetic help to try and keep you as comfortable as possible.
The valve that’s to be implanted is attached to a catheter. This is inserted into a blood vessel - often the femoral artery, which is accessed via the groin, although sometimes a small opening in the chest is used (without disturbing the bones in the chest).
The device is then slowly introduced upwards towards the heart, when it reaches the area of the aortic valve. When it’s in place, the new valve is deployed in place of the diseased native valve. This helps the valve open up and settle into place. After this, the catheter is gently removed and openings are closed up.
This has a quicker recovery time than open heart surgeries, too - we’d expect you to go through two or three days of recovery in hospital before getting home.
I would meet with you a couple of weeks afterwards to make sure that the valve is working well, by going through a heart scan and clinical examination. We’d also review your medications to see how they’re affected and what your ongoing medication options might be. As well as these, we’d also go through any other possible long-term therapies that might be suitable for you.
The procedure itself is designed to be a one-off. Despite being a newer procedure than some other heart treatments, the longevity of the valve implants used in TAVI whilst currently is limited to 8 years have had some really positive results so far. While there is always a slight risk of failure, it’s uncommon and we do keep you under long-term surveillance, so you’d reasonably expect to only have to undergo a TAVI procedure once.