Implanting a new aortic valve through a leg artery is one of the greatest advances in cardiac treatment options available. Dr Bassin is one of the few surgeons trained in TAVI and is able to counsel his patients about what procedure is best suited to their circumstances – whether it is surgical or non-surgical transcatheter valve replacement.
What is TAVI?
Transcatheter Aortic Valve Implantation is a procedure that involves replacing a dysfunctional aortic valve via a catheter guided through the leg artery (femoral artery). This means that patients can undergo aortic valve replacement without the need for major heart surgery. As one of the newer heart valve technologies, TAVI has been in practice for 10 years and is probably the biggest revolution in the treatment of heart valve disease since artificial valves were invented in the 1960s.
The aortic valve allows blood to flow out of the heart into the aorta to supply the entire body with the oxygen and nutrients contained in the blood. The most common reason that a patient would need a valve replacement is aortic stenosis whereby the valve fails to open fully. This commonly occurs with ageing as the valve leaflets become thickened and immobile with calcium. Once a patient starts experiencing symptoms such as shortness of breath or dizzy spells, they would be referred to a surgeon for consideration of valve replacement. Patients who are too high risk for open or minimally invasive aortic valve replacement may be considered for TAVI.
Who needs TAVI?
Patients with aortic stenosis who are experiencing symptoms of shortness of breath, dizzy spells or chest discomfort (angina) should undergo valve replacement to improve their chances of survival and to alleviate their symptoms.
TAVI is reserved for patients who are too high risk for open or minimally invasive surgery and this is because we don’t yet know the long-term results of TAVI. Patients who are commonly referred for TAVI include the elderly, those with multiple other medical issues such as kidney failure, and those that have undergone previous open heart surgery where a redo operation poses a very high risk.
What is involved?
Once you have been seen by Dr Bassin and deemed a reasonable candidate for TAVI you will be admitted to the hospital for a few days for a TAVI work-up (the procedure will not be performed at this time). This involves undergoing a number of tests and consultations with other specialists to ensure that TAVI is the right treatment for each individual patient. The patient will be placed on a waitlist and given an indicative timeframe for the procedure to take place.
The TAVI Work-up
You will be seen by an interventional cardiologist who performs the TAVI procedure with Dr Bassin, as well as an aged care specialist, a nurse co-ordinator as well as a team of physiotherapists, occupational therapists and other nursing staff.
There are also a number of tests for you to undergo during your hospital stay for your TAVI workup, these may include:
- CT scan (TAVI CT) to ensure that the leg arteries and heart valves are suitable for TAVI
- Coronary angiogram where a cardiologist injects dye into the heart with X-ray guidance to asses for any coronary blockages
- Lung function test
- Ultrasound of the carotid arteries
- Blood tests
The Heart Team
Once all of these tests and consultations have been performed a team of surgeons, cardiologists, aged care specialists and nurses meets to discuss each case – this is referred to as the ‘Heart Team’. This is a critical component of patient care and ensures that each patient receives the appropriate treatment.
The TAVI procedure can be performed with local or general anaesthetic depending on what is best for each patient. A needle is placed in both leg arteries at the hip crease (femoral artery) to gain access to the heart. Wires and catheters (hollow tubes) are threaded up into the heart and across the diseased aortic valve using X-ray guidance. A new valve which has been tightly compressed is then inserted through the tube via the femoral artery and threaded up though the old valve. The new valve is then deployed in place of the old valve and starts to function immediately. The wires and catheters are then removed and the patient is transferred to the intensive care or the recovery ward.
What is the recovery like?
The recovery after TAVI is very fast since there is minimal pain and discomfort. Many patients can go home after a day or two of monitoring depending on their function prior to their procedure.
What are the benefits and risks of this procedure?
Studies have shown that the risks of death and stroke are similar for TAVI and open valve replacement and are approximately 2-3% for patients who are otherwise relatively well. Other risks include bleeding from the leg puncture, injury to the femoral arteries, injury to the heart requiring urgent heart surgery and infection.
There is a higher risk of needing a permanent pacemaker for TAVI than for traditional open heart valve replacement and can be as high as 15%. There is also a higher risk of having a leaking valve following TAVI than traditional surgery because the previous valve is not removed.