Procedures

Transcatheter Aortic Valve Implantation (TAVI)

Why has my cardiologist recommended a TAVI?

Your heart is a pump, responsible for moving blood around your body. Four main valves control the flow of blood through the heart. When your heart contracts your aortic valve opens to allow oxygenated blood to flow around your body.
As we age calcium can build up on your valve, making it harder and thicker. This stops your aortic valve opening so your heart has to work harder to pump your blood through the narrowed valve. This is known as aortic stenosis.
Aortic stenosis may lead you to experience:

Shortness of breath
Chest pain
Dizziness of blackouts
Fatigue
Heart Failure

A severely narrowed aortic valve greatly increases your chance of dying and should always undergo assessment by a cardiologist. Replacing the damaged valve reduces the strain on your heart and helps to reduce the symptoms you have been experiencing, improving your quality of life and life expectancy.

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive replacement of a narrowed or leaky aortic valve.

What is a TAVI?

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive alternative to open heart surgery to replace the aortic valve. During the procedure an artificial valve, made from natural animal tissue, is used to replace your damaged aortic valve. The valve is passed through a tube, or catheter, which is inserted in the artery of the groin. TAVI is performed under local anaesthetic with a heavy sedative, and an anaesthetist is present to monitor you throughout the procedure.

Why have I been referred to a different cardiologist for this procedure?

Western Cardiology follow a sub-specialisation model of care, this means that your procedure will be performed by a cardiologist who has undertaken extensive additional training in procedures to manage structural heart disease. This style of practice has been shown to offer improved outcomes for patients, including:

Reduced complication rates.
Reduced re-admission rates to hospital.
Reduced length of stay in hospital.
Reduced mortality.

What should I expect during a TAVI?

At Western Cardiology all our procedures take place at St John of God in Subiaco. The procedure takes place in a specially designed cardiac procedure room (known as ‘the cath lab’). A TAVI requires a team approach, and there will be at least 2 senior consultants in the cath lab performing the procedure. An anaesthetist will be present during the procedure, they will apply either general anaesthesia or heavy sedation.
A cardiologist in the team will then:

Make a small puncture in your groin to access your blood vessel and insert a flexible tube known as a catheter.
Insert a tempory pacing wire into your heart to manage the rate at which your heart beats during the procedure.
Feed the catheter through your blood vessel up to your aortic valve.
Use a small balloon at the tip of the catheter to open the diseased valve.
Pass another catheter into the widened valve space and deploy a wire mesh containing the replacement valve. Your diseased valve is not cut or removed; it is simply pushed aside by the replacement valve.
Remove the catheters and tubes.

This process usually takes about 1 hour.

How should I prepare for a TAVI?

Before your TAVI you will undergo a CT scan to obtain important measurements of your valve and sometimes a coronary angiogram to rule out coronary artery disease as a cause of your symptoms.
Your case will be discussed at a multidisciplinary team meeting to make sure that this is the best option to manage your aortic stenosis.
You will be asked to have a thorough dental check up as tooth or gum infections can cause infections after a TAVI.
Your cardiologist may request that you stop taking some of your medications before the procedure.
Before the day of the procedure, please register with St John of God Subiaco Hospital admissions at www.sjog.org.au/myadmission and complete the online Admissions Form and follow their instructions. If you require any assistance please call 1300 863 566.
You will be admitted to SJOG Subiaco the evening prior to your TAVI.
You will be asked to fast for 6 hours prior to your procedure.

What are the risks associated with a TAVI?

A TAVI is a safe, common procedure, performed by a team of our highly trained Structural Cardiologists.
All procedures carry a small level of risk, commonly you may experience bruising or swelling in the groin where your cardiologist has accessed your blood vessel.
Uncommonly a TAVI may be associated with:

Bleeding or injury to the blood vessels in the leg
Kidney damage from the Xray dye
Slow heart beat which would require a pacemaker
Stroke
Emergency heart surgery or death following this procedure is rare.

Your individual risks will be discussed by your cardiologist before the procedure. They will depend on your age, your other medical conditions, and other factors.

Aftercare requirements

Following your TAVI you will be moved to the coronary care unit. Many patients are discharged the following morning, but you will be reviewed by a member of the heart team to make the decision about when you should go home. You may feel a little tender at the site of the catheter insertion and have some temporary bruising.
You will not be able to drive for two to four weeks after the procedure.
We ask that you avoid strenuous activity or heavy lifting for a week following the TAVI.
Some sort of blood thinner is required after TAVI, usually this is just low dose aspirin but this will be prescribed before you go home.
Our team will arrange to look at your new valve with an echocardiogram one month after the procedure and then you will speak to one of our doctors.

Our TAVI co-ordinator

Rob Lampard, the TAVI co-ordinator at St John of God Subiaco, will be closely involved with your care during the work-up process, while you are in hospital, and during follow up.
His email is Robert.Lampard@sjog.org.au