Transcatheter Aortic Valve Implantation (TAVI)
TAVI procedure has been designed to replace a diseased aortic valve by entering the heart via a catheter. Transcatheter means we use a catheter (a small flexible and hollow tube) to place a new aortic valve in the heart. This is done by making a small opening in an artery, then threading the catheter and the new valve into the heart. Until Transcatheter Aortic Valve Implantation (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 or Interventional Cardiologist is the doctor who 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.
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.
Transcatheter Aortic Valve Implantation (TAVI) Assessment
For the Heart Team to gain a complete picture of you and your health, we need to see you in our clinic in person. Appointments are coordinated over two or three days, but there may be a few days between clinic days. If you are travelling 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). During this time, we will conduct many heart tests, either at Norwest Private Hospital, or our affiliated hospital.
A letter with the days and times of your appointments will be sent to you, with information about where to go for the appointment. If you are in the hospital right now at Norwest Private Hospital, the cardiologist will explain the Transcatheter Aortic Valve Implantation (TAVI) procedure to you and answer any questions. Unlike open-.heart surgery, there is no need to open the chest for this procedure, as TAVI is generally performed under conscious sedation known as twilight sedation.
Is Transcatheter Aortic Valve Implantation (TAVI) the best option?
In order for us to decide whether TAVI would be the best option for you, we need a lot of information about you, your heart, and general health. Also, it is not just our decision. If we recommend TAVI, you can choose to continue with your current treatment instead, 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 own 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.
Is Transcatheter Aortic Valve Implantation (TAVI) your best option?
After your hospital visits, the TAVI team meets to review all the information gathered about you, including your assessment and the results of your heart tests. From this information, the team determines which option would be the best choice for treating your aortic stenosis. We aim to recommend the best treatment option for you, in keeping with your wishes and goals.
The best option may be:
- 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. Your doctor may ask you to return to the TAVI clinic in the future.
- 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:
- Transfemoral TAVI – means inserting the catheter into the femoral artery in the groin.
- Alternate access TAVI – means inserting catheters via alternate routes other than femoral such as subclavian (near the shoulder).
When will you know?
We call you within two weeks of your assessment visit to tell you what the team believes would be the best option. We will also send your local GP or doctor a letter. Take time and discuss with your family doctor or cardiologist about what we recommend.
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 pictures are kept in your chart.
Booked in for a TAVI?
Please ensure that you bring all your medications (including non-prescription medications and any supplements) with you when you come to the hospital. If you have any of your own teeth, make sure that you have seen a dentist within the last six months before your TAVI procedure is booked.
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.