Transcatheter aortic valve implantation (TAVI), also referred to as transcatheter aortic valve replacement (TAVR), is a procedure that replaces your diseased aortic valve with a man-made valve.
Your aortic valve controls blood flow from your heart to your body. If your valve becomes stiff, you have a condition called aortic stenosis. Your heart may have to work too hard to pump blood through the small valve opening to the rest of your body. This may lead to increasing heart failure.
The FDA approved TAVI for use in certain conditions. Before this approval, the procedure was available only through clinical trials. During the procedure, your doctor inserts a catheter through a blood vessel in your leg to deliver and implant the artificial valve into your heart. Significant research is exploring how to advance the use of this technique.
You may need TAVI if you have progressive heart failure due to aortic stenosis, but aren’t a good candidate for a traditional open-heart aortic valve replacement surgery. Conditions that would make open-heart surgery dangerous for you include:
- Advanced age
- Weaker heart
- Previous heart surgery
- History of stroke
- Chronic obstructive lung disease (COPD)
- Kidney disease
- Previous radiation treatment to your chest
- Large calcium deposits in the blood vessel that carries blood away from your heart (ascending aorta), called porcelain aorta
As more surgeons and surgical centers get more experience with TAVI, the risks are decreasing. However, TAVI is still a major procedure that requires general anesthesia (medicine that puts you to sleep and prevents you from feeling pain). Any general anesthesia includes risks for heart or brain injury.
The most common risks associated with TAVI include:
- Damage to your blood vessels
- Decreased blood supply to your brain, causing a stroke
- Heart attack
- Kidney failure
- Lung puncture
- Collection of fluid around your heart
- Failure of your replacement valve
- Severe heart failure
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
Before surgery, your medical and surgical team will evaluate your overall health. This may include X-rays, CT scans, blood tests, and other tests to check the health of your lungs and heart. Your medical team will also give you an echocardiogram to evaluate your aortic valve. This test uses sound waves to create images of your heart. Your medical team may also do a cardiac catheterization to evaluate your heart. You will also need to:
- Tell your healthcare provider about any drugs you are taking, including over-the-counter medicines.
- If you still smoke, ask your healthcare provider how soon before surgery you need to quit.
- Stop certain medicines if your healthcare provider instructs you to.
- Stop eating and drinking, usually at midnight before surgery. This is necessary because you will receive general anesthesia for the surgery.
Methods may vary, depending on your condition and your doctor's practices. Talk with your doctor about what to expect. Generally, a TAVI procedure follows this process:
- You will need to remove any jewelry or other objects that may interfere with the procedure.
- You will need to remove your clothing and will be given a gown to wear.
- You will need to empty your bladder prior to the procedure.
- An intravenous (IV) line will be started in your arm or hand. Additional catheters will be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as to take blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin.
- You will be positioned on the operating table, lying on your back.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Once you are sedated, a breathing tube will be inserted into your throat and into your trachea (breathing tube) to provide oxygen to your lungs. You will be connected to a ventilator, which will breathe for you during the surgery.
- A catheter will be inserted into your bladder to drain urine.
- A transesophageal echocardiogram (TEE) probe will be inserted into your esophagus to help visualize the valve.
- The skin over the surgical site in your groin will be cleansed with an antiseptic solution.
- Your surgeon will make an incision in your groin area to locate your femoral artery. This carries blood from your heart down into your leg.
- He or she will place a catheter into that artery and thread it to your heart and through your aorta, to reach your aortic valve.
- Your surgeon will also place other catheters in your heart to take measurements and X-ray pictures during the procedure.
- Your surgeon will guide your replacement valve, inside an expandable balloon, up the femoral artery catheter and through your old aortic valve.
- Once the balloon is properly positioned, your surgeon will expand it and implant the new valve to replace the old one.
- Your doctor will take measurements and images to make sure your new valve works properly, before removing the catheters.
- Your doctor will close your femoral artery and the incision in your groin area with sutures or clips.
You will be moved to the intensive care area of the hospital, so you can be monitored closely while you recover from surgery. As you recover, the tubes in your veins and arteries that give you nourishment and monitor your heart functions will be removed. You will soon be able to get up and walk and return to a normal diet. You may need to stay in the hospital for several days.
After your doctors feel you have recovered enough to go home, follow all instructions for medicines, pain control, diet, activity, and wound care. Make sure to keep all your follow-up appointments.
Complete recovery may take several weeks. Here are some helpful guidelines to follow as you heal:
- Your doctor may be give you blood thinning medicine to prevent blood clots after a TAVI. To make sure you’re getting the right dose, you may need to have your blood checked regularly.
- Walk around as much as possible.
- Gradually resume normal activities, but avoid any heavy lifting.
- Ask your doctors when you can resume driving, work, and sexual activity.
- Watch your groin for any sign of swelling, redness, bleeding, or discharge.
- Let your doctor know if you feel any pain or have fever, bleeding, or shortness of breath.
- Eat a heart-healthy diet and maintain a healthy weight.
- Don't smoke.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Transcatheter Aortic Valve Replacement Periprocedural Management, Up To Date, Transcatheter Aortic Valve Replacement: Outcomes and Complications, Up To Date, Transcatheter Aortic Valve Replacement Indications, Up To Date
Mancini, Mary, MD,Fetterman, Anne, RN, BSN