Transcatheter aortic valve implantation (TAVI)
What is transcatheter aortic valve implantation (TAVI)?
Transcatheter aortic valve implantation (also called TAVI and TAVR) is an option for the treatment of aortic stenosis for patients who are not suited for traditional open heart surgery.
Aortic stenosis is the progressive thickening and hardening of the heart valve flaps (known as leaflets) which restrict their opening when the heart contracts. This can cause a thickening of the heart muscle and a decrease in the flow of blood to the body and coronary arteries (arteries which supply blood to the heart muscle).
The most common intervention for heart valve replacement is open-heart surgery. However, a less invasive way of performing the surgery has been developed where the valve replacement is done without open heart surgery, known as transcatheter aortic valve implantation (TAVI).
The majority of TAVI valves can be inserted via the femoral artery (the main artery at the top of your leg).
What does the TAVI procedure involve?
A transcatheter aortic valve implantation (TAVI) procedure is usually performed under local anaesthetic but may involve a general anaesthetic in some cases.
A plastic tube called a sheath is inserted into a large arterial blood vessel in the groin. This allows catheters (thin tubes) to pass through the femoral (groin) artery into your heart.
A temporary pacing wire is inserted into a vein in the neck or leg and guided to the right ventricle (the pumping chamber of the right side of your heart). It is then connected to a temporary pacemaker, a small battery operated box, which can control the heart rate during the deployment of the valve. The temporary pacing wire is typically removed during the procedure but in rare cases it might be left in for a few days.
A transoesophageal echocardiogram (TOE) probe may be passed through your mouth and positioned in your oesophagus. This imaging helps guide and monitor your progress during the procedure. This is done while you are under general anaesthetic.
A thin tube with a balloon attached (balloon catheter) is then placed within the narrowed aortic valve. The balloon is inflated to open the narrowed leaflets (heart valve flaps) of the valve, and the balloon removed. X-rays are used to see the exact position of the catheters and the valve.
The valve consists of a bovine (from a cow) heart valve that is fixed on a metal frame. This valve is mounted onto another balloon catheter and passed through the sheath in your groin and placed in your now freely moving but still diseased aortic valve.
As the balloon is inflated the new valve is expanded to fit the opening of the diseased valve. The balloon catheter is then deflated and removed, leaving the new valve in place. Your own diseased valve will not be cut or removed, it is simply pushed aside by the new prosthetic valve. The new valve will immediately start to function.
This new procedure differs from the standard treatment offered for patients requiring valve replacement because it involves the insertion of a valve through a catheter via a small puncture in your groin rather than standard treatment which is via open heart surgery using a cardiopulmonary bypass machine to maintain the body’s blood circulation (being maintained by a machine outside the body). This avoids the need for open chest surgery and improves the patient’s recovery.
How long does the procedure take?
The procedure may take up to two hours.
How long will I be at the clinic for?
You will be admitted to the clinic on the morning of your procedure. Following your procedure you will be required to stay overnight for monitoring.
How do I prepare for a transcatheter aortic valve implantation (TAVI) procedure?
Provide informed consent
Your doctor will explain your procedure to you and answer any questions you may have. You will then be asked to sign a consent form.
You will find a copy of the consent form below. Please download and read this document in advance of your visit. Your doctor will discuss this with you on your arrival, if they have not already done so.
Consent for TAVI (Transcatheter Aortic Valve Implantation) – Transfemoral
If you have any questions or concerns, or require any additional information about your procedure in advance of your visit, please let your doctor know.
If you have access to a printer, then please print your consent form and bring it with you on the day of your procedure. Otherwise we will provide you with a copy on the day to sign with your doctor.
If you have already signed the consent in your doctor’s rooms, then please disregard this instruction.
Contact us the day before your procedure
Please ring us between 12 noon and 3pm on the day before your procedure [tel: 02 9382 0700] to confirm your time of arrival, fasting and medication instructions. Please ring on a Friday if your procedure is on a Monday.
If you have special needs (these are outlined in the Before my visit patient guide) please let us know one week in advance of your visit.
All patients attending Eastern Heart Clinic are fasted prior to their procedure. Please follow the fasting instructions that are given to you when you ring us the day prior to your procedure.
- All patients must cease solid food six hours before their admission time
- All patients must cease clear fluids two hours before their admission time (note: clear fluids are NOT cloudy or milky drinks)
- From two hours before your admission – nil by mouth
For example, if your admission time is 7:00 am (please tailor this to your admission time)
- You can eat food up until 1:00 am
- You can have clear fluids (water, black tea/coffee, clear juice etc) up until 5:00 am
We will confirm the time of your procedure and when you need to start fasting when you call the clinic the day before your procedure (please refer to our detailed instructions in the Before my visit patient guide).
Patients prescribed Warfarin
If you take the medication Warfarin you will need to consult with your referring cardiologist who will advise you if you need to stop taking your Warfarin three days before your procedure. Your cardiologist may also advise that you need to take a substitute anticoagulant (blood thinner). It is very important that you do not stop taking your Warfarin until you have discussed this with your cardiologist.
Patients prescribed Lasix
On the day of your procedure:
If your procedure is scheduled for before 12:00 pm: Withhold your Lasix and bring in your tablets so staff can give them to you after your procedure
If your procedure is scheduled for after 12:00 pm: you may take your Lasix
Patients with diabetes
If you are prescribed insulin we suggest you take half your regular insulin dose on the day of your procedure. Remind the booking staff that you are on insulin and we will attempt to schedule your procedure as early as possible.
Insulin dependent (IDDM): You should take half (½) of your regular insulin dose (please bring in insulin)
Non-insulin dependent (NIDDM) – tablet controlled: You should continue your medication as normal
Non-insulin dependent (NIDDM) – diet controlled: Fast as per the instructions above
Oral Sodium Glucose Inhibitors
If you take any of the following medication – Forxiga, Xigduo, Qtern, Jardiance, Jardiamet, Glyxambi, Steglatro, Segluromet, Steglujan – please contact Eastern Heart Clinic for instructions prior to your procedure.
Aspirin, Plavix, Prasugrel, Ticagrelor, Pradaxa, Apixaban, Rivaroxaban
Your cardiologist will provide advice regarding if and when to stop other medication. All other medications include Aspirin, Plavix, Prasugrel, Ticagrelor, Pradaxa, Apixaban, Rivaroxaban.
We will discuss your medications with you when you call the clinic the day before your procedure (please refer to our detailed instructions in the Before my visit patient guide).
Skin and nails
There are no special requirements before your procedure in terms of skin care, so just shower or bath as usual. However, please do not wear nail polish to your appointment.
What to bring
Please bring your current medications as well as any blood results.
Please read our patient guide Before my visit for other items to bring with you on the day, and for how to prepare for your procedure.
Can I drive, fly and resume normal activities?
You are advised not to drive for at least two weeks after your procedure. If your family doctor or your heart doctor has told you that you can’t drive in the past, you must check with him/her before you drive again.
Please arrange for someone to drive you home on your day of discharge if you are travelling by car, or to accompany you if you are travelling by taxi or Uber.
Please talk to our staff about when you will be able to fly (particularly if you need to fly home to a regional area after your procedure). Please note that some airlines place restrictions on patients flying after certain procedures. Our staff will be able to provide you with guidance and advice.
Ask your doctor when it’s safe to return to other activities such as work, sex, and leisure activities. It may take several weeks to months before you get back to all of your regular activities, depending on your overall health and heart health.
What if I have questions or concerns?
If you have any questions about your forthcoming procedure, please contact your referring cardiologist or Eastern Heart Clinic on tel: 02 9382 0700.
What will happen before, during and after my procedure?
For a detailed overview of how to prepare for your procedure and what to expect before, during and after your visit to Eastern Heart Clinic, please read the following patient guides: