Transcatheter Aortic Valve Insertion (TAVI)

Overview

Aortic Stenosis (AS), or narrowing or the aortic valve, is increasingly common as you get older.

It can be associated with symptoms of chest pain, breathlessness or even blackouts. The standard treatment is open heart surgery, which is excellent if you are otherwise well. Until TAVI, conservative management was often thought to be the best choice for very elderly and high risk patients, often leading to a slow decline in the patients’ health, as the aortic stenosis progressed.

The Edwards TAVI valve.

Do I need TAVI?

If you are at high risk for an open operation on your aortic valve, you may be suitable for TAVI. This is a novel procedure and you will need extensive investigation and then assessment by a multidisciplinary panel of specialists to see if your heart and body will be suitable for the procedure.

CT scan of the whole aorta to plan for a TAVI procedure.

What is involved and what are the risks?

As it is still a relatively new procedure it will only be considered if standard aortic valve replacement is felt to be too risky for you. There are several  approaches we can use:

  1. Via the leg- the transfemoral route  if your blood vessels are big enough,
  2. Via the chest- transapical route, directly to the heart through a small cut on the chest.
  3. Via the left shoulder- subclavian.

None are as invasive as open heart surgery.

Complications are possible, as only the higher risk patients get this treatment. The most common reported are:

  1. complications at the vascular access site (e.g., pain, bleeding, bruising);
  2. disruption of the normal electrical conduction system of the heart which may require treatment with a pacemaker;
  3. aortic regurgitation (leaking of the aortic valve that allows some blood to flow in the reverse direction).

However, it has been shown to be a life-saving treatment with dramatic improvements in quality of life.

See a video of a TAVI being performed:

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