TAVI
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 treatment options:
- Surgical Aortic Valve Replacement (SAVR)
This involves open-heart surgery performed under a general anaesthetic. The chest is opened through the breastbone (a 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.
The operation 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.
- Transcatheter Aortic Valve Implantation (TAVI)
TAVI is a less invasive procedure. It is performed using local anaesthetic and sedation, rather than a full general anaesthetic.
A small incision (about 1 cm) is made in the femoral artery in the groin. The new valve is guided up through the blood vessels and placed inside the existing valve, which helps hold it in position. The replacement valve is a tissue valve made from cow (bovine) or pig (porcine) tissue.
What happens when I come in for the procedure?
Before your TAVI, you will already have completed the required tests, which may include:
- An ultrasound of your heart (echocardiogram)
- A CT scan
- In some cases, a coronary angiogram
Based on these results and discussion between Dr Blusztein and the heart team at Cabrini, it has been decided that TAVI is the most suitable treatment option for you.
Admission and preparation
- You will be admitted to hospital on the afternoon before the procedure. • Nurses will perform blood tests and an ECG.
- You will be given special skin cleansing products to reduce the risk of infection.
- An anaesthetist will meet you to explain the sedation plan. This procedure usually does not require a general anaesthetic; instead, pain relief and sedatives are used to keep you comfortable.
- Dr Blusztein will also see you to answer any questions.
On the day of the procedure
- You will be taken to the cardiac catheterisation laboratory.
- After check-in, the anaesthetist will insert a small tube into your wrist to monitor your blood pressure throughout the procedure.
- Your wrists and groin will be cleaned with antiseptic and covered with sterile drapes.
- From this point onward, it is important to remain as still as possible.
Dr Blusztein will then insert small tubes (catheters) into the wrist and groin (transfemoral):
- One to visualise your existing valve
- One to act as a temporary pacemaker
- One to deliver the new valve
You may feel some pressure in the groin as the valve is guided from the leg up into the heart.
There are two types of valves that may be used:
- Self-expanding valves, which open using a controlled spring-loaded mechanism
- Balloon-expandable valves, which are opened by inflating a balloon
In both cases, the new valve is positioned inside your existing valve. The procedure usually takes about 60-90 minutes. Once finished:
- The tubes are removed
- Internal stitches are placed to close the blood vessels
- You will be asked to lie flat and avoid lifting your head to reduce pressure on the groin
You will then be taken back to the ward. Any remaining tubes are removed a few hours later. Most patients are able to sit up and walk around later that evening and sit up for dinner.
Are there risks?
Replacing a heart valve is a major cardiac procedure, whether done through open-heart surgery or a catheter-based approach. All heart procedures carry some level of risk.
We would only recommend this treatment if the benefits outweigh the risks. The specific risks vary between patients, and Dr Blusztein will discuss these with you in detail during your appointment.
What happens after the procedure?
- The usual hospital stay is around 2-3 days.
- You will have an ultrasound of your heart the following day to assess your new valve.
- Dr Blusztein will closely monitor your heart rhythm and check your groin wound sites.
Please note that current government regulations require you not to drive for four weeks after the valve procedure.
A follow-up appointment will be arranged, usually 30 days after the procedure, along with another echocardiogram. A letter will be sent to your GP and any other specialists involved in your care.
If you have questions at any time, please contact us.
Should I stop any medications?
- This will be discussed when your procedure is booked. Please provide a current list of all medications you are taking.
- If you are taking aspirin, you may continue it unless advised 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?
On the evening before the procedure, you may eat and drink as normal. You must then fast from midnight.
On the morning of the procedure, you may take your usual medications (unless advised 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.
