TAVI workup
What is the aortic valve?
Your heart is a strong muscle that pumps blood around your body. Blood leaves the heart through a large blood vessel called the aorta, which supplies oxygen-rich blood to your brain, arms, legs, organs, and even the heart itself.
Before blood enters the aorta, it passes through a valve called the aortic valve. This valve opens to allow blood to flow out of the heart and closes to stop blood from flowing backwards.
Over time, the aortic valve can develop problems:
- Aortic stenosis – the valve becomes stiff and narrowed, often due to calcium build-up.
- Aortic regurgitation – the valve becomes leaky, allowing blood to flow backwards into the heart.
Both conditions can cause symptoms such as shortness of breath, chest discomfort, dizziness, leg swelling, and tiredness. They both lead to progressive heart failure.
How is the aortic valve treated?
There are two main ways to treat a diseased aortic valve:
- Surgical Aortic Valve Replacement (SAVR)
This is traditional open-heart surgery performed under a general anaesthetic. The chest is opened through the breastbone (sternotomy), the damaged valve is removed, and a new valve is stitched into place.
The replacement valve may be:
- Mechanical (metal), or
- Tissue (bioprosthetic), made from animal tissue.
This surgery is performed in an operating theatre by a cardiothoracic surgeon. Patients usually spend one to two days in intensive care, followed by about a week on a cardiac ward. The full recovery is 6-12 weeks or so generally.
- Transcatheter Aortic Valve Implantation (TAVI)
TAVI is a minimally invasive procedure. It is performed under local anaesthetic with sedation.
A small (about 1 cm) incision is made in the artery in the groin (the femoral artery). The new valve is guided through the blood vessels and placed inside the existing valve, which helps hold it in position. TAVI valves are tissue valves made from cow (bovine) or pig (porcine) tissue.
During the procedure:
- You will be awake but relaxed and comfortable.
- Monitoring equipment will be attached.
- You will be able to talk with the team.
- The procedure usually takes about 60-90 minutes.
Afterwards, you will be transferred back to the ward. You will be mobilising 4-6 hours afterwards and discharge is usually after 2-3 days with return to usual activities.
What tests will I need before having my aortic valve treated, and how is the best treatment chosen?
All patients undergo a detailed aortic valve assessment, which includes three tests:
- Echocardiogram (heart ultrasound)
This test shows how narrowed or leaky your valve is and is usually done before your clinic review.
- Coronary angiogram
This test checks the arteries supplying blood to your heart. You will receive a separate information sheet explaining this procedure.
- CT scan
This scan from the upper chest to mid-leg allows Dr Blusztein to:
- Accurately measure your valve
- Assess your blood vessels
- Determine whether a catheter-based approach (TAVI) is suitable
Are there risks?
The assessment tests are generally low risk. The valve procedure itself carries more risk, as do all heart procedures.
We would only recommend treatment if the benefits outweigh the risks. Both surgical and transcatheter valve procedures have risks, which vary from person to person. Dr Blusztein will discuss these in detail with you during your appointment.
What happens after the procedure?
After the procedure:
- You will be taken to a recovery area for observation.
- You will then return to the ward.
If the procedure is performed via the wrist:
- You may sit up immediately and mobilise within 4-6 hours.
- You can eat and drink once back on the ward.
- Avoid heavy lifting with that arm for 48 hours (typing and writing are fine).
Most patients stay in hospital for two nights. The plastic dressing can be removed in the shower the day after the procedure.
Dr Blusztein will arrange a follow-up appointment, usually 30 days after the procedure, to:
- Review your results
- Adjust medications if needed
- Organise any further tests
A letter will be sent to your GP and any other specialists involved in your care.
Should I stop any medications?
We will discuss this when booking your procedure. Please provide an up-to-date list of your medications.
- If you take aspirin, continue taking it unless told otherwise.
- Please notify us if you take any of the following:
Important medications to tell us about
- Warfarin
- Apixaban
- Dabigatran
- Rivaroxaban
- Metformin
- Empagliflozin
- Dapagliflozin
- Insulin
Do I need to fast?
Yes. Please do not eat or drink anything from midnight before the procedure.
You may take your usual morning medications (unless told otherwise) with a small sip of water.
Who should I contact if I have questions?
If you have any questions or concerns, please contact us:
- Phone: (03) 9500 0296
- In person: Suite 17, Cabrini Hospital, Malvern
- Website: www.melbourneheart.com.au/contact
If your symptoms worsen while waiting for your procedure, please let us and your referring doctor know.
