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  • Mount Elizabeth

Transcatheter Aortic Valve Implantation (TAVI)

  • What is a transcatheter aortic valve implantation (TAVI)?

    A transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve replacement implantation (TAVI) is a minimally-invasive procedure for people with severe aortic stenosis.

    Aortic stenosis (AS) refers to a narrowing of the aortic valve opening which restricts the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium. AS may not result in much symptoms until blood flow is severely restricted which may lead to symptoms like:

    • Chest pain
    • Rapid heartbeat
    • Shortness of breath
    • Fainting spells
    • Swollen ankles or feet
    • Heart failure
    • Sudden cardiac death

    If left untreated, the survival rate for patients suffering from severe AS is only at 50% within 2 years.

    Usually a heart valve surgery requires an open heart procedure involving sternotomy, in which a vertical inline incision is made in the middle of the chest at the breastbone (sternum) to provide access to the chest cavity.

    A TAVR or TAVI allows an aortic valve to be implanted using a long thin and flexible tube (catheter) through very small incision made in the groin that leave all the chest bones in place. A minimally invasive heart surgery like TAVI may involve a shorter hospital stay, quicker recovery and less pain than traditional open heart surgery.

  • TAVR / TAVI may be an option for people who have severe aortic stenosis (AS) and are at intermediate risk for surgery, at high risk for surgery, or who are not suitable for open heart surgery. The procedure aims to ease the symptoms caused by AS and improve life span.

    Open heart surgery to replace the aortic valve is conventionally used to treat severe AS. However, the surgical risks are often high especially for elderly patients and those suffering from conditions that would increase their risk for open heart surgery.

    Factors making TAVI more likely to be recommended include:

  • Talk to your doctor if you have any questions about the procedure.

    Preparing for a TAVI procedure

    To prepare for surgery, you will need to undergo several tests to check that you are healthy enough to proceed with the operation. This may include:

    • X-rays and other imaging scans
    • Blood tests to determine the health of your heart and lungs
    • Echocardiogram to evaluate the function of your aortic valve
    • Cardiac catheterisation to evaluate the arteries supplying blood to the heart.

    During a TAVI procedure

    During a TAVI, a small cut is made near the groin. Next, guiding catheter (a thin and flexible tube) is inserted to implant the aortic valve, using the following steps.


    Inflatable balloon inserted into aorta

    Step 1: Balloon Valvuloplasty

    Guided by a catheter, an inflatable balloon is first inserted into your aorta to open up the heart valve.
    Transcatheter Heart Valve

    Step 2: Aortic Arch Navigation

    The transcatheter heart valve is guided through your artery into your heart.
    Artificial valve placed in position

    Step 3: Native Valve Crossing

    The artificial valve is placed in position in preparation for deployment.
    Valve locked in place

    Step 4: Deployment

    The inflatable balloon is used to deploy and lock the valve in place. There are also other TAVR / TAVI valves that are self-expanding and do not need a balloon for deployment.
    New valve functioning

    Step 5: Final Assessment

    The catheter is removed and the new valve is now working in place of the original diseased valve.

     

    Watch a video of the TAVR / TAVI procedure here:

     

    After a TAVI procedure

    Following the procedure, you may have to spend 2 – 4 days recovering in the hospital, which may include a period of observation at the intensive care unit (ICU), before you can be discharged.

    Your doctor may recommend that you make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.

    Recovery period for a TAVI procedure

    Complete recovery may take several weeks and varies depending on your health. During this time, it is important to care for the incision site carefully to prevent infection and take any medication that has been prescribed. You should also walk around as much as possible but avoid heavy lifting or strenuous activity.

    Follow your doctor’s advice on when you can resume normal daily activities such as driving or going back to work. Cardiac rehabilitation may be recommended to help improve exercise tolerance, functional capacity, and quality of life.

    Risks/complications of a TAVI procedure

    All medical procedures come with some type of risk. Complications from TAVI may include:

    • Infections that affect the heart
    • Vascular damage or injury from the insertion of the catheter
    • Valve leakage, possibly caused by a replacement valve that is too small or one that did not fully expand
    • Disruption of the heart’s electrical system, which may require the use of a pacemaker
    • Kidney damage from the contrast dye used for imaging
    • Perforation or tearing of the artery
    • Decreased blood supply to your brain, causing a stroke
    • Death, often resulting from the patient’s poor health prior to undergoing surgery and/or high risk profile
  • Mount Elizabeth Hospitals are established private hospitals with over 40 years’ experience serving patients with various heart conditions. We offer a comprehensive range of heart treatment such as transcatheter aortic valve implantation, supervised by an experienced cardiovascular team.

    Our facilities at both Mount Elizabeth Orchard and Mount Elizabeth Novena Hospitals, together with a multidisciplinary team of specialists, nurses and therapists are well-equipped to provide quality, customised treatment and support during recovery.

    Our experienced specialists are ready to provide advice on your suitability for TAVI and answer all your questions about the procedure.

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