TRANSCATHETER VALVE IMPLANTATION (TAVI)

Fixing aortic stenosis 

Typically conducted under local anaesthesia, transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure whereby a new valve is inserted without removing the  old, damaged valve.
The TAVI approach delivers a fully expandable replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.
Compared to surgical replacement it is less invasive, is generally performed under local anaesthesia and does not require cardiopulmonary bypass. Furthermore, TAVI results in a shorter hospital stay and a faster recovery.
Some patients unsuitable for surgery may now be treated using TAVI.
In addition, the incidence of death or stroke is 1-2 percent which is lower than conventional surgery.

How is TAVI performed

 In this video we demonstrate the implantation of an Edwards Life Science Sapien S3 Valve

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ABOUT AORTIC STENOSIS

Your heart contains four valves. These valves make sure that the blood flows through your heart in the correct direction. The aortic valve is on the left side of your heart and opens when the blood is pumped from your heart to the rest of your body. 
Aortic stenosis is the term used when the aortic valve is narrowed or cannot open properly, so the blood can’t flow easily out of your heart to the rest of your body.
Aortic stenosis puts extra strain on your heart and can affect your blood circulation. This can result in breathlessness, swollen ankles, chest pain, dizziness, and, sometimes, blackouts as well.
The type of procedure that your cardiologist and your cardiac surgeon have recommended for you is called a transcatheter aortic valve implant or TAVI for short.

ABOUT TAVI

For people with aortic valve problems, the usual treatment is open heart surgery to repair or replace the aortic valve.
However, open-heart surgery may not be the best option for people who are older or unwell, or who have already had one or more heart surgeries in the past.
The TAVI procedure for implanting aortic valves through a catheter is less invasive and may reduce your recovery time and length of hospital stay.

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WHAT DOES TRANSCATHETER MEAN?

Transcatheter aortic valves are designed to be implanted using a long, narrow tube called a catheter. The catheter can be inserted through a large artery at the top of your leg or through a small incision in your chest.
The valve is made of natural tissue from the heart tissue of either a cow or a pig. The natural tissue is reengineered and attached to a flexible expanding mesh frame.

REFERRAL FOR TAVI​

Aortic stenosis is diagnosed by your general practitioner listening for a murmur. An echocardiogram quantifies the severity of the valve pathology. After referral for consultation and echocardiogram,  the cardiologist may discuss treatment options for your valve which could include TAVI or cardiac surgery.

TRANSCATHETER VALVE IMPLANTATION

DURING YOUR TAVI PROCEDURE

Your implant procedure will probably take about one to two hours . It is done in the cardiac catheterisation laboratory.
Once you are in the procedure room, the anaesthetist doctor will start your anaesthesia.
If you are having local anaesthesia, the doctor will use a type of anaesthesia medication that helps you relax and feel sleepy. You will also have “freezing” medication in your groin so you do not feel any pain. In fact, you may sleep right through the whole procedure.
With some types of TAVI procedures, you may require general anaesthesia. This means you will receive medications that will completely relax all of your muscles including your breathing muscles. With general anaesthesia, once you are asleep, the doctor will put a breathing tube in your mouth. This tube is connected to a breathing machine. Usually the breathing tube is removed before you are fully awake.
All other equipment such as intravenous lines, a heart monitor, and a temporary pacemaker will be put in after you are asleep.
Once your implant procedure is completed, you will be transferred to the intensive care unit.

WHAT ARE THE RISKS OF THE TAVI PROCEDURE

What are the Risks and Possible Complications of a TAVI Procedure?

Before giving your consent to have a TAVI procedure, your doctor will explain the possible risks and ask you for directions should you experience a life-threatening complication. Below is a list of some of the complications that can happen during a TAVI procedure.

Blood Vessel Injury/Bleeding: The TAVI catheter is placed in a large artery in your groin, therefore there is a risk of injuring the artery and causing bleeding or blockage which may require surgical repair.

Kidney Injury/Failure: During the TAVI procedure, a special dye is injected into your bloodstream to make your aortic valve and blood vessels show up under X-ray. This dye can be toxic for your kidneys which, in rare cases, can lead to dialysis.

Need for a Permanent Pacemaker: When the TAVI valve is implanted, it can sometimes interfere with the electrical conduction system in your heart. If this happens, you will need to have a permanent pacemaker.

Stroke: During the TAVI procedure, there is a possibility some of the c alcified plaques that have built up around your aortic valve may break away and become lodged in small arteries in your brain. This may lead to a stroke.

Death: In some cases, life-threatening complications may occur while you are having the TAVI procedure.

What Happens if a Life-Threatening Complication Occurs During My Tavi Procedure?

A TAVI is a complex procedure with possible life-threatening complications that would require emergency surgical intervention to save your life.

Some examples of these complications include:

  • Tear of the wall of the aorta

  • Tear of the root of the aorta where the TAVI valve is placed

  • Perforation of the heart

  • Dislodgement of the TAVI valve after it has been placed

If this type of complication occurs, the decision about whether to proceed to emergency surgery will be made by your doctors according to your wishes and consent.

Emergency surgery, in this setting, carries a greater risk of death and other complications. As such, it is very important you and your family have a discussion about what you want.

You will be asked, at the time of the consent signing, whether you wish to have emergency surgery in the event of a life-threatening complication. This will help your doctors decide how to proceed if this unlikely situation is to occur.

FOR THE FAMILY/CONTACT PERSON

Once your procedure is completed, the doctor will want to contact your family to let them know how you did. The doctor can either talk to your family in person or call a designated family member on the telephone.
If your family wants to speak to the doctor in person, we will refer them to the lobby volunteer desk where they can register with the volunteers and wait in the Family Lounge.
If you want the doctor to call a specific family member, the staff will ask you for the name and phone number where your family member can be reached.
The staff will ensure those arrangements are made with you and your family before your procedure starts.

Southern Cross will reimburse the cost of a Transcatheter Aortic Valve Implantation under a member’s policy when all the following criteria are met as reviewed and agreed by the Heart Team.

1. The patient has symptomatic severe calcific aortic stenosis or deteriorated surgical tissue aortic valve

2. The patient must have a life expectancy of more than 2 years

3. The patient is at intermediate or higher risk which is defined as either an STS-PROM score of 4% or more; or

an STS-PROM score of at least 3% and has increased risk due to:

  • 75yrs+

  • Heart failure

  • Lung function- FEV1 <1000ml

  • 5-metre gait speed ≥ 6 seconds

  • Severe diastolic dysfunction

  • Liver disease

  • Pulmonary Hypertension  ≥ 50mm Hg

  • Frailty

  • Previous open heart surgery

4. The patient is technically suitable for TAVI.

The patient must meet 1-4 as agreed by the Heart team before referral for a Pre-TAVI CT scan for final assessment of technical suitability. To access the STS-PROM calculator online please type 'STS-PROMO calculator" into your search engine e.g. google

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