What is transcatheter aortic valve implantation?

Transcatheter aortic valve implantation (TAVI) is a procedure to implant a replacement aortic valve in the heart. It is also called transcatheter aortic valve replacement (TAVR). Your doctor will use a thin, flexible tube called a catheter to put in your new heart valve.

Your doctor will put the catheter into a blood vessel in your upper leg (groin) or chest. The doctor moves the catheter through the blood vessel and into your heart.

The replacement valve fits inside the catheter. The valve is made of tissue and metal. Your doctor will move the new valve into your damaged valve. It will expand and work in place of the old valve.

You may be asleep for the procedure, or you may get a sedative to help you relax. You won't feel pain when the catheter is put in the blood vessel.

You may stay in the hospital for up to a few days.

Activity

• Do not do strenuous exercise and do not lift, pull, or push anything heavy until your doctor says it is okay. This may be for several days.
• If the catheter was placed in your groin, try not to walk up stairs for the first couple of days.
• Rest when you feel tired.
• Ask your doctor when you can drive again.

Diet

• Eat a heart-healthy diet. If you have not been eating this way, talk to your doctor. You also may want to talk to a dietitian. They can help you learn about healthy foods.
• If your bowel movements are not regular right after the procedure, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Your doctor may prescribe aspirin or some other blood-thinning medicine. Be sure to get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Care of the catheter site

• For 1 or 2 days, keep a bandage over the spot where the catheter was inserted. The bandage probably will fall off in this time.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your skin.
• You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry.
• Do not soak the catheter site until it is healed. Don't take a bath for 1 week, or until your doctor tells you it is okay.
• Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.
• If you are bleeding, lie down and press on the area for 15 minutes to try to make it stop. If the bleeding does not stop, call your doctor or seek immediate medical care.

Other

• Practice good dental hygiene and have regular checkups. Good dental health is especially important. That's because bacteria can spread from teeth and gums to the heart valves.
• Be sure to tell all of your doctors and your dentist that you have a replacement aortic valve. This is important because you may need to take antibiotics before certain procedures to prevent infection.

This procedure can help people who have aortic stenosis feel better and live longer.

But how well this procedure works depends on several things, such as other health problems that a person has. These include other heart problems. Doctors are still learning who might benefit the most from TAVI.

Because TAVI is a newer treatment, doctors don't yet know the long-term benefits or risks. They also don't know how long the valves will last. But research shows that they work well for at least 5 years.

TAVI may take about 2 to 3 hours.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• You will have several tests to get ready. These may include echocardiograms and a CT scan.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

TAVI doesn't involve open-heart surgery. But the procedure does have serious risks. Some risks last just a short time. Others are long-term.

Risks include:

• Heart block. This is a problem with the electrical system in the heart. It can cause a slow heart rate. If this happens, a person may need a permanent pacemaker.
• Injury to the blood vessel used to put the catheter in the heart.
• Serious bleeding problems.
• Leaking around the valve.
• Heart attack.
• Stroke.
• Death.

Transcatheter aortic valve implantation (TAVI) is a procedure to implant a replacement aortic valve in the heart. It is also called transcatheter aortic valve replacement (TAVR). It is done to treat aortic valve stenosis. In aortic valve stenosis, the valve between your heart and the large blood vessel that carries blood to the body (aorta) has narrowed. That forces the heart to pump harder to get enough blood through the valve. TAVI can help some people feel better and live longer.

In TAVI, the doctor uses a thin, flexible tube called a catheter to put in the new heart valve. TAVI is not an open-heart surgery.

• While you are in the hospital, your doctors and nurses will monitor you to check how the new valve is working.
• You will receive information from the hospital about diet, activities, and medicine.
• You will need to have regular checkups with your doctor.
• Your doctor may suggest that you attend a cardiac rehab program. In cardiac rehab, a team of health professionals provides education and support to help you recover and prevent problems with your heart. Ask your doctor if rehab is right for you.
• You may take aspirin or some other blood thinner to prevent blood clots. If you get a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

TAVI is done to treat narrowing (stenosis) of the aortic valve. This is the valve between your heart and the blood vessel (the aorta) that carries blood to your body. TAVI may also be done to place a new valve in an existing tissue replacement valve.

TAVI is typically done through an incision (cut) in the groin. But sometimes a small cut is made in the chest. The doctor uses a tube called a catheter and special tools that fit inside the catheter. The doctor puts the catheter into a blood vessel and moves it through the blood vessel and into the heart. A specially designed replacement valve fits inside the catheter. This valve is made of tissue and metal. The doctor then moves the new valve into the damaged aortic valve. The new valve expands and works as your new aortic valve.

You may be asleep for the procedure. Or you may get medicine that relaxes you or puts you in a light sleep. You won't feel pain when the catheter is put in the blood vessel. You may stay in the hospital for up to a few days after the procedure.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or you may get medicine that relaxes you or puts you in a light sleep. You won't feel pain when the catheter is put in the blood vessel.
• The procedure may take about 2 to 3 hours.
• After the procedure, pressure may be applied to the area where the catheter was put in your blood vessel. This will help prevent bleeding. A small device may also be used to close the blood vessel. The area may be covered with a bandage or a compression device.
• Nurses will check your heart rate and blood pressure. The nurse will also check the catheter site for bleeding.
• If the catheter was put in your groin, you will need to lie still and keep your leg straight for up to a few hours. The nurse may put a weighted bag on your leg.
• You may have a bruise or a small lump where the catheter was put in your blood vessel. This is normal and will go away.