TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI)
What is a TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI)?
A TAVI is a procedure to replace a diseased aortic valve that fails to open and close properly.
The aortic valve is the valve between the main pumping chamber of your heart (left ventricle) and the main artery to your body (aorta). The aortic valve usually opens when blood is pumped from your heart to the rest of your body. Heart valve surgery is routinely performed by heart surgeons. More keyhole procedures are being introduced, enabling interventional cardiologists to perform these traditionally surgical procedures in the cath lab or hybrid cath/surgery labs.
Peninsula Private Hospital offers keyhole TAVI procedure. Dr Gregory Szto is an accredited TAVI operator who works side-by-side with surgeons in a state-of-the-art hybrid cath lab to enable this less invasive valve replacement procedure, which results in shorter healing times and faster discharge from hospital.
Why do I need to have a TAVI?
TAVI may be recommended if you have aortic stenosis, a condition where the aortic valve cannot open and close properly. This condition puts extra strain on your heart and can result in breathlessness, chest pain, dizziness, and sometimes, blackouts.
You may be considered for a TAVI if you are at high risk for open heart surgery.
What does the procedure involve?
TAVI is a procedure in which an artificial valve is implanted into your heart using a long narrow tube called a catheter that is fed through your blood vessels.
To assess your suitability for TAVI, the following tests are performed:
- Blood tests
- Diagnostic coronary angiogram and stent if required
- CT aortogram to measure the dimensions of your valve, aorta and passage of TAVI catheter
- Carotid CT and Dental scan
- Geriatric assessment by a geriatrician
- Surgical assessment by a cardiac surgeon
Your medical history and test results will be discussed at a TAVI team conference to determine your suitability.
Can I eat or drink before my procedure?
You will be asked to present to hospital on the day prior to your procedure. Your anaesthetist, cardiologist and geriatrician will assess you pre-operatively. You should fast at least 6 hours before your procedure.
Do I take my medications on the day of the procedure?
Unless advised by your doctor, you should continue to take your usual medications. Some blood-thinning medications may need to be stopped prior to the procedure.
Where do I go to have the procedure?
TAVI is performed at Peninsula Private Hospital in the cardiac hybrid laboratory (‘cath lab’) which converts to an operating theatre.
What do I need to bring?
It is recommended that you bring with you to the hospital:
- Your hospital admission paperwork with a signed consent form, health insurance details and Medicare /DVA card.
- Your current medications in their original containers.
- An overnight bag with your belongings, as you will be required to stay 2-3 days in hospital for monitoring after the procedure.
What happens during the procedure?
You will be given heavy sedation or a general anaesthetic during the procedure.
A temporary pacemaker wire may be inserted from the side of the neck.
Both groin arteries will be prepared and sheaths inserted.
A special “Sentinel” filter will be deployed via the right wrist artery to prevent a stroke.
A thin flexible tube with a balloon at its tip may be inflated across the diseased valve (balloon aortic valvuloplasty).
The new valve will then be positioned across the diseased aortic valve and deployed.
How long does the procedure take?
The procedure takes approximately 1 – 2 hours and you will remain in hospital for 2 – 3 days.
What are the risks?
The risks associated with TAVI are:
- Bleeding or injury to the arteries requiring surgical repair
- Abnormal heart rhythms (which may require a pacemaker in 5 – 10%)
- Obstructed coronary artery (which will be dealt with during the procedure with coronary stenting)
- Aortic regurgitation (which will be dealt with during the procedure with further balloon dilatation)
- Kidney impairment
- Stroke (reduced with a “Sentinel” filter)
Your doctor will explain the risks to you prior to the procedure. You are also encouraged to discuss any questions or concerns with your doctor and your family.
After the procedure
After the TAVI, you will be moved to the coronary care unit. Your heart rate, pulse and blood pressure, and neurological signs will be closely monitored. Any pain or discomfort in the groin/neck/wrists will be treated with analgesics.
An echocardiogram (ultrasound of the heart) will be performed at days 1 and 30 post procedure.
People can usually start walking within 12-24 hours after TAVI.
You will need to organise for someone to come and pick you up from the hospital to take you home after the procedure.
A copy of your procedure will be sent to your referring doctor and a follow up appointment with your cardiologist will be arranged on discharge.
What will I need to do after I go home?
You can resume most gentle activities with no heavy lifting for 4 weeks.
You will need to continue taking all of your medication unless instructed otherwise.
After TAVI, a combination blood thinning medication (e.g. Coplavix®) is given for 6 months.
You may resume your usual activities over the coming weeks.