Dr Iqbal Malik is a leading London specialist in TAVI procedures
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 yellow arrows show the diseased aortic valve. One of the TAVI valves, the Edwards Sapien Valve is shown below.
Do I need TAVI?
If you are at higher 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.
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:
- Via the leg- the transfemoral route if your blood vessels are big enough. This is the easiest and best route.
- Via the chest- transapical route, directly to the heart through a small cut on the chest.
- Via the shoulder- subclavian or axillary artery.
- Transcaval- via a large vein.
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:
- complications at the vascular access site (e.g., pain, bleeding, bruising);
- disruption of the normal electrical conduction system of the heart which may require treatment with a pacemaker;
- 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 videos of a TAVI being performed: