Trans-catheter Aortic Valve Replacement
This page is intended to give you a clearer understanding
of what having a Transcatheter Aortic Valve Implant (TAVI)
will involve for both you and your family.
Please remember this is a general guide of what is likely
to happen and there will be differences from person to person.
Any of the nurses and doctors who are looking after you will
be happy to answer your questions and deal with any matters
that may be worrying you.
Valvular heart disease
Your heart is a muscle which pumps blood to your lungs
and around the rest of your body. There are four valves
in your heart.
Normally, these valves open to let blood flow through or out
of your heart, and then shut to keep it from flowing backwards.
If your valve is diseased or damaged this can affect the flow
of blood to your heart in two ways.
1. If the valve does not open fully, it will obstruct the flow
of blood. This is called valve stenosis.
2. If the valve does not close properly, it will allow blood
to leak backwards, in the wrong direction. This is called
valve incompetence or regurgitation.
What are the symptoms of valvular heart disease
The symptoms of valvular disease vary depending on which
valve is affected, they may include:
a. tiredness or breathlessness when exercising
l palpitations or feeling like your heart is racing.
b. chest pains (angina) because there is not enough blood
flowing through the coronary arteries, which supply
the heart muscle with blood.
c. spells of dizziness and fainting, this can happen
if the obstruction is severe.
The back pressure (the effect of blood flowing backwards)
can also cause shortness of breath and swelling of the ankles
Transcatheter aortic valve implant (TAVI)procedure
For some people one way of treating their particular heart
problem is to insert a new aortic valve percutaneously
or through an artery via the skin. This means that we may not
have to perform open heart surgery and the procedure can
be performed in a similar approach as the angiogram which
you have already had.
Before the start of the procedure, to help you to relax,
an anaesthetist will give you some sedation; then local
anaesthetic will be used to numb the groin and a small cut
is made to insert a tube into the artery. The balloon catheter
(a soft catheter with an inflatable balloon at the tip) is inserted
into the top of your leg (groin) and fed through an artery
to the heart. Doctors are guided by x-ray screening to direct
the catheter until it enters the aorta.
Once the balloon catheter is in the correct position, the balloon
is inflated to make way for the new valve. The replacement
valve is a tissue valve, mounted on a self expanding frame, which
is placed in the aorta to improve blood flow. Once the new valve
is in the correct position, the balloon catheter is removed.In 20% of patients, the doctor may decide to insert the
balloon catheter through an artery near the collar bone. If this
is the best treatment for you, we will tell you this and talk to
you about what it will involve. We will give you a general
anaesthetic and you will be put to sleep. It is likely that you
will be transferred to a Cardiac High Dependency Unit (CHDU),
following the procedure, to recover from the anaesthetic.
If you do not already have a pacemaker, we may insert
a temporary pacemaker before inserting the balloon catheter
through your artery.
A pacemaker is a device that uses electrical impulses to regulate
the heart rhythm. The doctors can use the temporary pacemaker
to increase your heart rate, which is important during valve
replacement to ensure correct positioning. The temporary pacemaker is a wire which can be inserted
through either your arm or leg. The doctors will explain this
procedure to you during your clinic appointment so that when
you come into hospital, to have the operation, you understand
what it will involve.
20% of all people who undergo the TAVI procedure will require
a pacemaker permanently. This is usually inserted one or two
days following the TAVI procedure, whilst you are still in
hospital. We will discuss this with you during your clinic appointment before your hospital admission. The doctors and
nurses looking after you can answer any questions or concerns
you may have regarding pacemakers.
Are there any risks?
The TAVI procedure has a success rate of more than 95%,
however, as with any heart procedure there are risks attached
and they vary from person to person. We will explain to you
when you come for your appointment at the clinic and again
when you come to sign the consent form.
If you have any questions or concerns, ask your doctor or nurse.
During the procedure
The procedure lasts approximately one and a half hours and
when it is finished you will be taken back to the Cardiac Care
Unit (CCU). If you require a higher level of care, then we will
transfer you to our Cardiac High Dependency Unit (CHDU).
We will close the puncture site in your groin with a device
that seals the artery. The nurse looking after you will regularly
inspect your groin, check your blood pressure and check the
pulses in your feet.
We will observe your heart rhythm on a cardiac monitor for
four to six hours. You will need to lie flat during this time.
During the procedure, we may have to access arteries in both
groins. This may mean you have to lie flat for longer. If there are
no problems with the insertion site, such as bleeding or swelling,
you will be able to sit out of bed the following morning.
There is limited space in the ward, so we suggest you do not
bring too many things with you into hospital.
While you are in the Cardiac High
Dependency Unit (CHDU) it may not always be possible to care
for you with other patients, who are the same sex as you,
because we will be using specialised equipment as part of your
care. However to make sure of your privacy and sense of dignity
we provide substantial screening around your bed, to preserve
your privacy and dignity.
Brighton and Sussex University Hospitals Daily Visiting Hours:
3pm – 5pm 7pm – 8.30pm
To enable nurses and doctors to attend to your needs during
visiting time, we ask that visitors are limited to two people at
the bedside, at any one time.
After the procedure:
Everyone has a different response to this procedure so these
suggestions are guidelines only. If you have any doubts talk
to the doctor or nurse about what you can do.
We advise you not to do anything strenuous, after returning
home. So avoid lifting heavy objects (e.g shopping, suitcases)
excessive pulling and pushing (e.g cutting the grass, digging
the arden, shovelling and vacuum cleaning).
Give yourself a week or two to get your strength back before
returning to your everyday activities. A good starting point is
to take regular walks that you increase on a daily basis. You do
not have to avoid climbing stairs or walking up hills just take
them slowly and steadily at first. After this period you should
be back doing the things you used to do and you may even find
that you can do more if dizziness or breathlessness was holding
you back before.
Driving: It is advisable not to drive for one week after this procedure.
If you have an LGV or PCV license you will be required
to undergo an exercise test before getting your license back.The same will apply for train drivers and pilots.
Returning to work: This will depend on many factors such as the overall state
of your health and the type of work that you do. If you have
been working up until the time of your procedure you should
be able to return to work within a week or so. You may like
to discuss this in more detail with your consultant or GP.
It is safe to fly to any destination 10 days after your treatment,
provided you have not had any complications and you are the
passenger and not the pilot!
Going home: If there have not been any problems, you should be able to go
home two to four days after the procedure.
If you have any problems organising your own transport home,
then do talk to the ward staff as soon as you can. We suggest
that you organise for someone to go with you to the transport
as the staff on your ward will not be free to go with you.
Wound Care: It is normal for your groin to feel tender for a few days after
the procedure. A bruise may develop as far down as your knee.
If you develop a hard tender lump under the skin around the
cut/wound, get in touch with your GP. This may be the result
of a collection of blood, or haematoma, under the skin.
We also advise you to avoid hot baths for 48 hours as this may
The artery sealing device leaves a stitch under the skin and your
wound will be secured by some steri strips (paper stitches)
and covered with a clear dressing. You can peel off the clear
dressing 24 hours after going home and the steri strips should
be left until they dry and they peel off on their own.
In the highly unlikely event of your wound starting to bleed, lie
down flat and get a family member or friend to apply pressure
to your groin. If the bleeding does not stop within ten minutes,
call an ambulance immediately.
Tablets: Following Transcatheter Aortic Valve Implant (TAVI) you will
be given two medicines, Aspirin and Clopidogrel (PLAVIX), which
you are required to take every day for six months. After six
months, you will only need to take a daily dose of Aspirin.
Both of these medicines will prevent clots from forming inside
the newly inserted valve.
We will give you one month’s supply of these tablets and send
a letter to your GP, explaining the treatment you have had while
in our care. This letter will also list the medicine we have
prescribed for you.
Sex: You and your partner may be worried that sex will put the heart
under a great deal of strain and cause some damage. Your fears
are understandable but in fact your heart will not be damaged.
Generally, once you are managing everyday activities you can
safely resume sex when you and your partner feel ready.
Research has shown that the physical effort during sexual
intercourse from start to finish is no more than climbing 20 stairs
Cardiac Rehabilitation: In Brighton you are invited to attend a rehabilitation
programme approximately two weeks after discharge. It is
held twice weekly for seven weeks. The programme includes
graduated exercise and general health discussions lasting
for two hours. Your level of fitness is taken into consideration.
If you live outside the Brighton area you will be referred to
the Cardiac Rehabilitation Nurse at your local hospital. They
may then contact you regarding their service.
People who have been on the rehabilitation programme say
that the main benefits are that they feel more confident about
coping with everyday life. They also find that the exercise
programme helps them increase their level of fitness.For more information on Cardiac Rehabilitation click HERE
Hospital follow up: All patients will come for follow up appointments at the hospital,
which will include echocardiograms, or ultra sound scanning of
the heart. This will monitor the efficiency of the new heart valve.
The appointments will take place after one month, then one
year after the procedure. An annual follow up appointment will
be necessary thereafter.