Transcatheter Aortic Valve Implantation (TAVI)

A Transcatheter Aortic Valve Implantation (TAVI) is a procedure performed by an Interventional Cardiologist designed to replace a diseased aortic valve. Transcatheter means using a catheter (a small flexible and hollow tube) to place a new aortic valve in the heart. The Transcatheter Aortic Valve Implantation procedure is performed by making a small opening in an artery, then threading the catheter and the new valve into the heart. Until TAVI was developed, the only solution to replace a diseased heart valve was open-heart surgery.

TAVI is a less-invasive procedure

TAVI is a less-invasive procedure than open-heart surgery and is a superior medical treatment for inoperable patients. A Cardiologist will diagnose you with Aortic Stenosis, and if you have been diagnosed with Severe Aortic Stenosis, you can discuss the opportunity of undergoing TAVI as treatment option.

What is Aortic Stenosis

Aortic Stenosis is a serious disease affecting the aortic heart valve. Aortic stenosis affects mostly seniors, and people in their later years of life. Aortic Stenosis usually presents with breathlessness, fainting and some chest pain, so if you or your loved one is experiencing breathlessness, fainting and some chest pain, please talk with your doctor at your earliest convenience.

What is TAVI Assessment and how do I get one?

1. Referrals can be made to Norwest Private Hospital’s Heart Valve Team to be assessed for a TAVI. During the TAVI assessment the Norwest Heart Valve Team will gain a complete picture of you and your health. You can request a referral letter from your regular GP or Cardiologist and you will need to visit our clinic in person.
2. Appointments are coordinated over two or three days, but there may be a few days between clinic days. If you are traveling to Sydney for the assessment, we try to schedule your visits over two or three days in a row (remember to book your hotel for at least two or three nights).
3. At your appointment, we will conduct many heart tests, either at Norwest Private Hospital, or our affiliated hospital.
4. A letter will be sent to you outlining the days, times and location of your appointment.
5. If you are in the hospital right now at Norwest Private Hospital, your treating cardiologist will explain the Transcatheter Aortic Valve Implantation procedure to you and answer any questions.
6. Unlike open-heart surgery, there is no need to open the chest for this procedure, as TAVI is performed under conscious sedation known as twilight sedation.

Is TAVI the best option for me?

After you undergo a TAVI assessment the Norwest Heart Valve Team will decide whether TAVI would be the best option for you. The Norwest Heart Valve Team need a lot of information about you, your heart, and general health. Also, it is not just up to the Norwest Heart Valve Team to decide.  If the Norwest Heart Valve Team recommend TAVI, you can choose to continue with your current treatment, or talk to your doctor about other options. But it is important to make your decision after we have seen you and given you information about your options.

Every person undergoes a thorough review before deciding if TAVI is an option. If you decide that you want to know if TAVI is an option, you will need to come to the hospital for at least two visits (sometimes more). If you are from out of Sydney, you will need to make your travel and hotel arrangements for these days. If you are in the hospital right now, you may have the tests done while you are admitted.

After your hospital visits, the Norwest Heart Valve Team will meet in a case conference to review all the information gathered about you. This information will include your assessment and the results of your heart tests. From this information, the Norwest Heart Valve Team determines which option would be the best choice for treating your Aortic Stenosis.

The aim of the Norwest Health Valve Team is to recommend the best treatment option for you in keeping with your wishes and goals.

TAVI and other Heart Valve Treatment Options

• Medical Management: This means your aortic stenosis is best managed without surgery for now. Your family doctor or heart specialist (cardiologist) will continue to monitor and treat your aortic stenosis with medication. If your aortic stenosis is becoming worse, your doctor may ask you to visit the Norwest heart Team for a TAVI assessment.
• Surgical Aortic Valve Replacement: This means open heart surgery is the best option for you. Arranged through your referring doctor, a cardiac surgeon’s office will contact you to discuss this option more.
• Transcatheter Aortic Valve Implantation (TAVI): This means TAVI is the best option for you to have your aortic valve replaced. If Transcatheter Aortic Valve Implantation (TAVI) has been chosen, this means TAVI is the best option for you to have your aortic valve replaced.

There are two ways your heart valve can be replaced:

1. Transfemoral TAVI – means inserting the catheter into the femoral artery in the groin
2. Alternate access TAVI – means inserting catheters via alternative routes other than femoral such as subclavian (near the shoulder)

When will you know the Norwest Heart Valve Team’s decision?

We will call you within two weeks of your assessment visit to discuss what the heart valve team believes would be the best option for you. We will also send your local GP or your referring doctor a follow up letter with the outcome. Please take the time to discuss with your family doctor or cardiologist about what is recommended for you.

The Transcatheter Aortic Valve Implantation review process:

• Step 1: Appointment for TAVI assessment is scheduled
• Step 2: Attend hospital for TAVI assessment. This may take two hospital visits, on at least two separate days.
• Step 3: The team reviews the results of your work-up and recommends the best option for treating your aortic stenosis
• Step 4: You and your doctor are notified of our team’s decision. If TAVI is the option of choice, we will book your procedure to have your aortic valve replaced

What to expect during the clinic visits

• We will discuss with you – what is TAVI, how TAVI is done, and the risks and benefits of this type of procedure
• You will have time to ask your questions
• We provide information about how the team decides which treatment option is best for you
• A range of different heart tests
• Other tests include a walking test and memory test
• Questions about your everyday life, understand what you can and cannot do for yourself, your living situation and your heart symptom
• A doctor gives you a medical check-up and asks you questions about your heart and your health
• Our heart surgeon reviews your health record. The doctor may wish to examine you further
• Pictures of you are taken to help the team when they meet to discuss your treatment options after your clinic visit. The images are kept in your chart

Information for patients undergoing a TAVI procedure?

Patient Instructions

Please ensure that you bring all your medications (including non-prescription medicines and any supplements) with you when you come to the hospital. If you have your original teeth, make sure that you have seen a dentist within the last six months before your TAVI procedure is booked.

Additional Info

Patients with valve replacements may have an increased risk of developing an infection of the heart valve and the surrounding tissue called endocarditis. Check with your doctor; you may need antibiotics before some surgical procedures or dental visits.