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Transcatheter Aortic Valve Implantation (TAVI)

OverviewTAVI

A normal heart valve allows blood to flow in one direction only without obstruction. A valve that is narrowed is said to have "stenosis". Aortic stenosis (narrowing of the aortic valve that lies between left ventricle and aorta) is the most common valve problem and is usually due to calcium building up on the valve leaflets so they become rigid and restrict blood flow.

Aortic stenosis may lead to:
  • Shortness of breath due to heart failure with build up of fluid in the lungs.
  • Angina because of insufficient blood reaching the heart muscle.
  • Blackouts because of insufficient blood reaching the head.
  • Sudden death.
There is an important breakthrough for replacing the aortic valve called Transcatheter Aortic Valve Implantation (TAVI) - also called Transcatheter Aortic Valve Replacement (TAVR). 

Surgical aortic valve replacement is still the standard form of treatment for most patients with severe symptomatic aortic valve stenosis but this is changing as trial results are beginning to show that TAVI (TAVR) has a lower death rate and lower stroke rate than surgical aortic valve replacement. 

For patients who are too high risk for surgery, TAVI can be an alternative with much better outcomes than medicines alone.
 
To see more about Transcatheter Aortic Valve Implantation (TAVI) refer to the documentary featured on TV 3's Close Up programme.

How is TAVI performed?

The procedure is conducted in an angiography suite (“cath lab”) at Mercy Angiography, which is within the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your interventional cardiologist will be assisted by nurses and other highly trained staff. As the procedure is performed using general anaesthesia, you will not be aware of anything during the procedure.

Access is gained via the femoral artery and the delivery catheter with the aortic valve prosthesis is advanced to the narrowed valve. 
 


 


Using a balloon, delivered via a catheter inserted from a small incision in the groin, the diseased valve is pushed aside by inflation of a Balloon (Aortic Balloon Valvuloplasty).
TAVR 1(copy)
 
TAVR 2(copy)(copy)


 
The new valve, loaded in a specialised delivery catheter, is then advanced to the stenosed aortic valve via a small hole in the femoral artery in the groin (Retrograde technique) or a small incision in the chest (Transapical technique).
 

Once correctly positioned, the external sheath of the delivery system is progressively retracted deploying the prosthesis.

The prosthesis is composed of leaflets made from bovine pericardium (the strong but thin membrane that surrounds a cow's heart) and is mounted on a stainless steel frame.
TAVR Edwards(copy)
TAVR 4(copy)(copy)
 
TAVR 5(copy)


The delivery catheter is then closed and retrieved.


 
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What happens after my TAVI procedure?

  • After the procedure patients will be transferred to Mercy Hospital's Intensive Care or Coronary Care Unit for recovery.
  • Patients will have a urinary catheter until they're mobile, an intravenous (IV) line, a temporary pacemaker in the neck vein and may need an oxygen mask.
  • Patients can expect to be on their feet the same day or the next day at the latest.
  • After coronary care, the patients will go to a less intensive monitoring environment. They will have chest electrocardiogram (ECG) leads and two small boxes to carry around (one to transmit ECG signals to a central station and another to pace the heart if necessary).
  • There may be bruising at the puncture site.
  • Patients will have a consultation on rehabilitation.
  • Hospital stay for recovery is likely to be between 2 to 7 days.
  • The prosthesis delivery abolishes the aortic valve narrowing.
  • Important leakage is uncommon.
  • There is a >95% chance of achieving this without death or stroke and almost all patient have improvement in symptoms.
  • Tissue heart valves deteriorate with time but so far this uncommon although the procedure is relatively new. Deterioration is likely to be similar to that of a surgically implanted valve.
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How should I prepare for my procedure?

  • Fasting: You must not have anything to eat or drink six to eight hours before you procedure, unless the Anaesthetist tells you otherwise. You may continue to drink a small amount of clear fluids to take medications.
  • Medication: Please inform your cardiologist about all the medication you are taking. You cardiologist may advise you to stop taking some medication temporarily for a few days prior to your procedure e.g. blood thinners.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Mercy Angiography staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic you should inform your cardiologist and Mercy Angiography staff at the time of booking your procedure. You may need to discuss your insulin dose with your cardiologist.
Please bring with you any medication and any recent blood test results, ultrasound results or x-rays.

On the day of your procedure, please make your way to the Mercy Hospital Reception where they will be expecting you. You will be admitted to a hospital ward and transferred to Mercy Angiography for your procedure.

For directions to the Mercy Hospital, click here.

 
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What are the benefits of TAVI?

  • Of patients with severe aortic stenosis who have symptoms and who do not have valve replacement, between 50 and 80% will be dead in two years.
  • There is increasing evidence that TAVI (TAVR) has a significantly lower death rate and a lower stroke rate than surgical valve replacement in medium and high risk patients.
  • The TAVI valves appear to be durable. 
  • There are many patients who are not suitable or are high risk for surgical replacement because of one or more of the following –advanced age; conditions such as kidney problems, chest problems, problems with blood supply to the brain, weak heart muscle or previous heart surgery. TAVI may be a suitable alternative. 
  • TAVI (TAVR) is likely to become an increasingly widely used alternative to surgical aortic valve surgery. 
  • There is no major incision in the chest and a heart lung machine is not used. 
  • Recovery is a lot quicker than after conventional surgery. 
  • Many patients who have previously been turned down for surgery or are very high risk may now be treated using TAVI.
 
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How can I be considered for TAVI?

To date, there has been very limited funding by insurance companies for this procedure so this procedure currently is patient-funded.

In order to be considered for a TAVI procedure, you would need a referral from a cardiologist that it could be suitable for you. Please contact our friendly team at Mercy Angiography and we can help you through this process, regardless of the stage you're at.

 
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Video Demonstrations

          View Edwards Prosthesis deployment