If you have been diagnosed with aortic stenosis, a transcatheter aortic valve implantation (TAVI), is a non-surgical procedure which medical staff may discuss with you as an good option.
The aortic valve is one of four valves which controls the flow of blood out of the heart. Aortic stenosis occurs when the aortic valve narrows because it has thickened, stiffened or fused together and fails to open properly. This can make you feel breathless and faint, with heart palpitations and chest pain. If you are considered suitable for a TAVI, its benefits include, reducing:
- shortness of breath
- chest pain and fainting
- the risk of heart failure and death
Every medical procedure carries some risk, risks which differ for different people. Your doctor will discuss the risks with you before/if you decide to go ahead with a TAVI. The risks include:
Strokes
Three percent of people have a stroke following a TAVI procedure, although strokes can can be treated with clot-busting drugs.
Heart surgery
One percent of people will need open heart surgery to correct complications which occur during the TAVI procedure. Complications which may result in heart surgery include:
- a ruptured artery
- perforated heart chambers
- displacement of the TAVI valve
Heart attack
There is a risk (0.7%) of having a heart attack during a TAVI. This can occur when an artery supplying the heart (a coronary artery) gets blocked. If this happens, the doctor will try to open the blocked artery by stretching it with a balloon and inserting a small metal tube (called a stent) in place to keep the artery open. This is called coronary angioplasty.
Bruising, bleeding and/ or pain
Five percent of people will have major bleeding caused by damage to the artery. The artery may get damaged where the catheter is inserted or where the valve is implanted. Damage to the heart wall can cause blood to collect around the heart.
Femoral/iliac artery complications
Four to five percent of people have major femoral artery complications. Damage to the femoral (groin), or iliac artery, may need surgery, or repair using a keyhole procedure through the groin.
Irregular heart rhythm
Following TAVI, around 10% to 20% of people will need a permanent pacemaker because their heart rhythm has not returned to normal.
Leaking of the aortic valve
Fewer than 5% of people will have moderate to severe leaking of the aortic valve (aortic regurgitation), which allows the blood to flow in the wrong direction. Severe leaks are repaired by stretching the valve with a balloon, having a second TAVI, or open heart surgery.
Kidney function damage
There is a risk (2.5%) of damaging kidney function, and higher if you already have poor kidney function. The kidneys usually get back to normal without treatment but there is a chance (1–2%) that some people need haemodialysis, a procedure which uses a machine to perform the kidneys' function of cleaning the blood.
Death
Between 1% and 4% of people who have the TAVI procedure die within 30 days.
To get more precise vision, your doctor may use X-rays, a fluoroscopy (a small x-ray film of your heart), or transoesophageal echo (TOE) to fit the new valve correctly.
By using an ultrasound scan's sound waves, a TOE transmits moving pictures of your heart. This is done by passing a flexible tube (a probe) down your throat, to send sound waves to your heart, and collect bounced back echoes.
Risks of imaging
If you have a TOE, your doctor will put a small tube into your food pipe (oesophagus) while you are under general anaesthetic. Fewer than 0.01% have complications from a TOE, such as damage to their teeth, throat or gullet.
If you have any complications, you may need to stay on the intensive therapy unit (ITU)/recovery unit or adult intensive care unit (AICU) a few days longer than usual.
If you have any questions, please talk to your doctor.
Before your TAVI
Even if a TAVI is initially considered a good option, you will still be referred to a consultant cardiologist who may still do some tests. TAVI is not suitable for everyone, so they will need to make sure that it is the right procedure for you.
Tests
Before confirming your TAVI procedure you may have one or more of the following tests:
Blood tests
Blood tests check your general health. Your nurse can tell you what we are checking for.
Electrocardiogram (ECG)
For an ECG, electrodes (small sticky patches with leads) are put on your arms, legs and chest. The electrodes are connected to a monitor that records the rhythm and electrical activity of your heart. The test takes about 10 minutes.
Echocardiogram (echo)
An echocardiogram uses sound waves to build up a moving picture of your heart. It helps doctors learn more about the structure and function of your heart valves and heart chambers. An echocardiogram takes around 30 minutes.
Computed tomography (CT) scans
A CT scan is an X-ray that produces three-dimensional images of your body. A radiographer will give you an injection containing a special dye so that your blood vessels and heart show clearly on the scan. A CT scan takes about an hour.
Cardiac magnetic resonance (CMR) scans
A CMR scan uses a magnetic field and radio waves to take pictures inside the body. The scan helps doctors see the structure of your heart and blood vessels, and how well they are working. A CMR scan takes about an hour.
Coronary angiogram (cardiac catheterisation)
A coronary angiogram is a procedure that uses a series of X-rays to allow doctors to look at the main arteries that supply your heart muscle – the coronary arteries. A thin plastic tube (catheter) is guided through an artery in your groin or wrist to your heart. Then a special dye is injected through the catheter so your arteries show clearly. A coronary angiogram takes about 30 minutes.
Respiratory (lung) function test
A respiratory function test measures how well your lungs are working. You will blow into a machine through a tube.
Walking test
A walking test helps doctors see how far you can walk in six minutes. We will only ask you to take this test if it is comfortable for you.
Carotid dopplers
This is a painless ultrasound scan of the blood vessels in your neck. The test takes between 15 and 30 minutes.
Test results
After your tests, a specialist healthcare team will discuss your results, and decide which treatment may be best for you.
The specialist team includes heart surgeons, cardiologists, radiologists (imaging specialists), anaesthetists and specialist nurses. If the team agrees that a TAVI is the right treatment for
you, a member of the TAVI team will call you to arrange a convenient date for you to have the procedure.
Improving your health before your TAVI can reduce the risks and help ensure your TAVI is successful.
Stop smoking
If you smoke, try to stop completely, several weeks before your TAVI. Stopping smoking reduces the risk of breathing problems and makes your procedure safer. For support to help you give up smoking:
- talk to your GP or pharmacist
- call SMOKEFREE (free NHS helpline) on 0800 022 4332, or visit the smokefree website
Control your weight
If you are overweight, losing weight will reduce the risks associated with having a TAVI. Talk to your GP or practice nurse about helping you to lose weight.
Dental check-up
A dental check-up to make sure your teeth and gums are health can help to avoid damage during a TAVI, and reduce the risk of infection. Germs (bacteria) can enter the bloodstream via your teeth and gums and get into the heart, which can cause a condition called endocarditis. Endocarditis can damage the heart valves and cause other serious complications.
Loose teeth or crowns can also be problematic. Having dental treatment before a TAVI may reduce the risk of tooth damage if the anaesthetist inserts a tube to help you breathe. Ask your TAVI nurse for advice.
Visit your GP
Ask your GP for a check-up if you have ongoing medical problems such as diabetes, asthma, bronchitis, thyroid problems or high blood pressure.
Pre-admission assessment
You will receive an appointment to attend a pre-admission clinic approximately two weeks before your hospital admission date. We will check your general health and fitness, do some blood tests and a test for MRSA (methicillin resistant staphylococcus aureus). MRSA is a common infection but if you have it, we will need to treat it before your TAVI. If we need to delay your TAVI for any reason, we will explain what happens next.
Arriving at hospital
When you arrive at at Royal Brompton Hospital, a receptionist at the main reception will direct you to your ward. At Harefield Hospital, ask for the admissions office when you get to main reception. From there, an admissions officer will process your paperwork and direct you to the ward.
On the ward
When you get to the ward, a nurse will show you your bed. Male and female patients may share the same ward, but will have separate bays and bathrooms. In intensive care and high-dependency areas, however, male and female patients may be cared for in the same bay.
We cannot guarantee a time that your TAVI will take place and, unfortunately, there may be delays if other patients need to be seen in an emergency. Staff on the unit will keep you informed.
Hygiene
We will give you an antiseptic body wash to use before your TAVI. It is very important that you have a thorough shower or bath the night before, and on the morning of, your TAVI. Please pay special attention to washing under skin folds such as under the breasts, the groin and genital area.
Do not shave or remove hair from your chest, arms, legs or groin before your TAVI. If needed, shaving will be done in hospital just before your TAVI.
Contact with the anaesthetist
When you're admitted, you will see the anaesthetist or doctor/nurse responsible for your sedation during the procedure. Your anaesthetist/doctor/nurse will discuss your general health, medicines or allergies you have, and any previous anaesthetics you've been given. have had. Please let your anaesthetist/doctor/nurse know you're taking:
- anticoagulants (medicines to prevent blood clots)
- diabetes medication
- antidepressants
The anaesthetist/doctor/nurse will also plan your immediate post-TAVI care, including pain relief and recovery. Your anaesthetist/ doctor/nurse can answer any questions you have, or you can contact the TAVI nurse at the hospital.
Food and drink
Do not eat anything on the morning of your TAVI. You can drink water, black tea or black coffee up until the procedure.
Medication
Continue to take your medicines as usual, unless your TAVI nurse or cardiologist has asked you not to.
Smoking
To reduce the risk of breathing problems during your procedure, do not smoke on the days leading up to your TAVI.
Pre-meds
Pre-medication (also called pre-meds) are drugs sometimes given before your anaesthetic. Some pre-meds prepare your body for the anaesthetic, and others help you to relax.
Immediately before your TAVI
Before your TAVI, you'll be requested to remove all jewellry, dentures and hearing aids before undressing and putting your hospital gown on. The anaesthetist/nurse will then put a cannula (small flexible tube) in a vein in your hand.
When you're ready for your TAVI, a member of staff will take you to the cardiac catheterisation laboratory (cath lab), on a bed or chair. Cath lab staff will check your identification and confirm your treatment. If you are having a general anaesthetic you will have a ventilator (artificial breathing machine) to help you breathe. Machines will monitor your heart rate, blood pressure and oxygen levels during your TAVI.
After your TAVI operation, you will go to the recovery unit for observation. There, you'll have a drip (intravenous line) put into your arm so you can have antibiotics and fluids. A heart monitor will continue to measure your heart rate and rhythm. If you are not well enough to go to the ward, you may go to the intensive therapy unit/recovery unit.
Dressing
You will have a dressing on the site where the catheter was inserted. You may have some bruising around the area and it may feel a little tender. The dressing will be removed before you go home.
Going home after your TAVI
Most people go home between two to five days after their TAVI. If there are any complications, you may need to stay in hospital a little longer. When you leave hospital you will be given a patient information leaflet called ‘Going home after trans-cathete aortic valve implantation (TAVI)’. We'll also give you an ID card with the name and type of your valve. You will need the ID card if you have an MRI scan in the future.
Follow-up care
If you feel unwell after your TAVI and think you need urgent treatment, contact your TAVI nurse or go to the nearest accident and emergency (A&E) department. You will have a follow-up appointment after your TAVI which may include an echocardiogram, to check how well your valve is working.
If you have any questions about your procedure, you can contact your TAVI nurse.
Harefield Hospital
TAVI clinical nurse specialist
Phone: 01895 823 737 extension 85023
Parkwood House visitor accommodation
Phone: 01895 828 823
Outpatients
Phone: 01895 828 695
Oak and Acorn wards
Acorn Ward
Phone: 01895 828 121
Oak Ward
Phone: 01895 828 667 or 01895 828 648
Find out more about Acorn and Oak wards, including visiting times.
Royal Brompton Hospital
TAVI department
Phone: 020 7351 8121 extension 82398
TAVI clinical nurse specialist
Phone: 020 7351 8110 or 0207 351 8371 and ask for bleep 1194
South Parade visitor accommodation
Phone: 020 7351 8044
Outpatients
Phone: 020 7351 8011
Intensive therapy unit (ITU)/recovery unit
Visiting times are 11am to 1pm and 3pm to 7:30pm every day. Only close family members can visit you on the ITU/recovery unit.
Adult intensive care unit (AICU)
Phone: 020 7351 8587
Find out more about the adult intensive care unit, including visiting times.
Visiting
We recommend that family and friends contact the individual ward directly to confirm visiting times before they come to the hospital.
Find out more about visiting patients at Royal Brompton and Harefield hospitals.
Patient Advice and Liaison Service (PALS)
If you have any concerns about any aspect of the service you have received in hospital and feel unable to talk to those people responsible for your care, contact the confidential Patient Advice and Liaison Service (PALS):
Royal Brompton Hospital
Phone: 020 7349 7715
Email: gstt.rbhh-pals@nhs.net
Harefield Hospital
Phone: 01895 826 572
Email: gstt.rbhh-pals@nhs.net
TAVI has been approved by the National Institute for Health and Care Excellence (NICE). If you want to know more about anaesthetics in general, find out more from the Royal College of Anaesthetists.