Transcatheter Aortic Valve Implantation (TAVI), known as TAVR in America, is a minimally invasive keyhole procedure used to replace the aortic valve in patients with severe aortic stenosis (narrowing of the aortic valve). It avoids the need for traditional open-heart surgery.
The aortic valve is the main valve that allows blood to flow from the heart’s main pumping chamber (left ventricle) into the aorta and around the body. Aortic stenosis is usually caused by the natural degeneration and narrowing of the valve over time. As the valve narrows, the heart must work harder to pump blood around the body.
Common symptoms include breathlessness, fatigue, chest pain and, occasionally, dizziness.
Dr Hilling-Smith is a highly regarded structural interventional cardiologist with extensive experience performing TAVI procedures. He completed advanced structural heart training in England more than 10 years ago and has successfully performed hundreds of TAVI procedures with excellent outcomes. He is regularly invited to teach other cardiologists throughout Australia his TAVI techniques.
Where appropriate, Dr Hilling-Smith inserts a Sentinel cerebral protection device via the wrist before deploying the TAVI valve and removes it at the end of the procedure. The Sentinel device is designed to capture debris and help reduce the risk of significant stroke during the procedure.
Dr Hilling-Smith has one of the highest rates of Sentinel device use in Queensland, reflecting his commitment to achieving the safest possible outcomes for his patients.
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.
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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.
• Most people remain in hospital for two to three days following a TAVI procedure.
• Some bruising in the groin area is normal and should be expected.
• A follow-up echocardiogram is usually performed the day after the procedure to assess the function of the new valve.
• You must not drive for 4 weeks after the procedure
• Walking is recommended as your primary form of exercise until your clinical review, which is typically scheduled around 6 weeks after the procedure.
• Most patients notice a significant improvement in their symptoms, energy levels and overall fitness during the recovery period.
• There are generally no long-term activity restrictions following a successful TAVI procedure.
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