The aortic valve is the most important valve in the heart. Degeneration can occur with aging, along with previous heart valve infection or rheumatic fever. These processes can lead to both restriction (aortic stenosis) and/or leakiness (aortic regurgitation) of the heart valve leaflets.
When the valve is diseased, this can cause tiredness, breathing difficulty, chest pain or even black out.
The conventional method for aortic stenosis treatment is open heart surgery where the valve is usually excised and replaced with either a tissue (cow’s, pig’s or cadaveric) valve or mechanical/metallic valve. This will improve forward flow from the heart and improve patient’s symptoms as well as to make the patient to live longer.
Transcathether aortic valve implant is an alternative to open heart surgery in selected patients. A collapsed stent valve is inserted usually through the groin artery into the heart, like a conventional coronary angiogram; once the valve is in position, it will be the opened up to be secured in the desired position. In some patients the TAVI will be done through the chest wall through a small incision in the chest, with a wound that is smaller than traditional open heart surgery.
Not all patients are suitable for TAVI. All patients who end up having a TAVI need to be seen by both a cardiac surgeon as well as a cardiologist, along with possibly a whole team of specialists to determine the best treatment option.
Your cardiologist will advise if there is to be any change to your usual medication prior to the procedure. Medications such as warfarin, xarelto (rivaroxaban), pradaxa (dabigatran) and eliquis (apixaban) will need to be stopped prior and your cardiologist will remind you.
Most TAVI patients will be admitted the day before the procedure. This will provide a chance for the surgeon, cardiologist, and anaesthetist to review the data prior to the case day.
Please advise the staff if you are aware of any allergies you may have. X-ray Dye (contrast solution) used in in this procedure contains Iodine. If you have an allergy to Iodine, you must inform your doctor prior to this procedure.
A small plastic tube will be inserted into a vein in your arm and an intravenous drip will be connected to it. You may be given a mild sedative prior to the procedure to help you relax.
Your groin area or arm will be clipped and you will be asked to shower using an antiseptic soap and dress in a hospital gown.
The procedure is performed in a special theatre called the Cardiac Catheter Laboratory, where you already would have had an angiogram.
Electrodes are attached to your arms, chest, legs and back.
An anaesthetist will be there during the procedure, and some cases are performed under general anaesthetic but some will be done under heavy sedation. In any case most patients will be mostly unaware during the cases.
A large tube (catheter) will be inserted into the groin artery after sedation. You should not be aware of pain or the catheter going into the artery. The procedure takes 30min to 60 min to complete.
Once the TAVI is placed, before the patient is woken up, most of the tubes/catheters in the groin will be removed at the conclusion of the case. Sometimes there will be a tube left in the neck overnight. This is likely to be removed the next morning.
At the conclusion of the case, you will wake up usually feeling the effect of the anaesthetic still, i.e. a little drowsy for about half an hour to an hour. You may feel pain in the groin where the catheters have been inserted. You should request for pain relief if this happens. The nurse will be checking your groin for bleeding regularly.
After the TAVI you will be transferred to the intensive care unit for monitoring.
You will be drowsy, and may have some groin pain. If general anaesthetic was used, the breathing tube will have been removed from your throat and this may cause some residual discomfort. Usually the pain settles down with simple pain relief like panadol / paracetamol.
You will be allowed to sit up in bed after a few hours. Some patients will be able to walk around the ICU on the same night. You will be allowed to have dinner generally, on the same night.
Most patients will be transferred to the ward after one night in ICU. Most patients will be allowed home on day 2 or 3 after the procedure.
Precaution at home
You will be asked not to drive for at least one week, and not to partake in heavy exercises/exertion or carry heavy load for at least one week.
Occasionally there will be minor ooze or bleeding from the groin. You should consult your cardiologist immediately, or ask a family member to put pressure on the bleeding point. This is very rare however.