Transcatheter Aortic Valve Intervention (TAVI or TAVR in America) is a procedure to treat patients with severe aortic stenosis (narrowing) usually due to natural de-generation of the aortic valve. The aortic valve is the main valve coming off the heart and allows blood to go from the main pumping chamber (left ventricle) to the aorta and around the body.
If the valve narrows, then the heart must work even harder to pump blood around the body.
This usually leads to symptoms of breathlessness, tiredness or fatigue, chest pain, and occasionally dizziness.
The outlook for someone with severe aortic stenosis if it is not fixed is very poor.
Before the TAVI procedure was invented, the patient’s only option was open heart surgery.
Before:
The decision to perform a TAVI procedure involves extensive work-up investigations, most people are admitted to the hospital for 3 days to have all of the relevant tests – these include a coronary angiogram to look at the heart arteries, a CT scan to allow Dr Hilling-Smith to choose the correct size and style of valve in your individual case, breathing tests, walking tests, memory tests and neck scan.
You will also meet several other members of the team including general medical specialists, the TAVI coordinators, and an open-heart surgeon (to see if that is also a possibility in your case).
Once all the work-up investigations have been performed, the patient typically goes home, and Dr Hilling-Smith will present your case at the Heart Valve Team Meeting. During the meeting, all the results are reviewed and a formal recommendation made for your specific case. If you are approved for a TAVI procedure, then this will be booked in the next few weeks.
During:
• The TAVI procedure is done in a Cardiac Cath lab.
• Usually performed whilst you are awake with what most people call a ‘twilight anaesthetic’. An anaesthetist will be there to ensure you are made comfortable and pain-free and you may or may not remember it afterwards. Doing the procedure whilst awake (when appropriate) leads to quicker recovery and better outcomes, especially in older patients where the effects of general anaesthetic can be more significant.
• The heart valve is inserted through the artery at the top of the leg and is roughly the size of your little finger. There is no cutting involved. The procedure is usually very well tolerated and takes about 90 minutes.
• Where possible, Dr Hilling-Smith will insert a basket device called a Sentinel into the neck arteries, via the wrist, before deploying the TAVI valve (and remove it at the end). This is done to take every possible step to reduce the risk of significant stroke during the procedure.
• Dr Hilling-Smith has by far the highest rate of Sentinel use in Queensland.
After:
• Most people stay in hospital a couple of days after a TAVI procedure.
• Some bruising in the groin is inevitable.
• You have a check echocardiogram the next day.
• You are not allowed to drive for 4 weeks.
• You should do only walking for exercise until your clinical review in about 6 weeks, your fitness and symptoms usually improve significantly after that.
• There are no long-term restrictions after a TAVI procedure
A TAVI procedure is done to treat severe stenosis (narrowing) of the aortic valve and avoids the need for open heart surgery. The TAVI procedure relieves symptoms of breathlessness and tiredness and takes significant strain off the heart. The outlook without treatment is very poor, but the TAVI procedure is very well tolerated, and long-term results are excellent. The TAVI procedure is complex and requires significant planning and tailoring for your individual needs.
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