TAVR / TAVI
Transcatheter aortic valve replacement / implantation (TAVR / TAVI) is a relatively recent technique to treat aortic valve disease. Historically aortic valve disease has been managed with open heart surgery to implant a new valve. With TAVR / TAVI a new valve is taken up to the heart through a tube in the leg artery (or sometimes the arteries under the collar bone or in the neck). After careful assessment, your doctors in consultation with a team of heart specialists, including an interventional cardiologist and a heart surgeon, may recommend this less invasive procedure to treat your condition.
Aortic valve disease
The left ventricle of the heart pumps blood to the brain and the rest of the body through the aortic valve. This one-way valve is a normally a thin, flexible structure that opens to let blood through and closes to stop blood coming back. But the valve can harden and narrow (aortic stenosis), and sometimes leak (aortic regurgitation or incompetence). This can happen for many reasons, including as part of the ageing process or because of genetic factors, birth abnormalities, diabetes, high blood pressure, cholesterol, smoking, infections or radiation therapy.
For less-advanced disease, treatment is often medication and close observation. However, in advanced cases – as assessed by your general practitioner, cardiologist and other treating specialists – an intervention such as TAVR / TAVI may be appropriate.
The TAVR / TAVI procedure
There are two major types of TAVR / TAVI valve, which are made of a metal frame with cow and/or pig tissue. One self-expands into position (self-expanding valve) and the other is ballooned into position (balloon expandable valve). Both can be effective treatment options with similar long-term outcomes. The choice of valve depends on your aorta and aortic valve’s shape, size and degree of hardening. In this procedure:
- Anaesthetic is administered (this may be a full general anaesthetic and include being put on to a breathing machine, the specifics of which your doctors will discuss with you).
- An ultrasound probe is placed down your oesophagus to visualise the heart.
- Tubes are inserted into the arteries in each of your legs, the vein in your neck and / or leg and sometimes in your wrist or arm. A surgeon may need to make an incision to get to the artery.
- A temporary pacemaker wire is threaded through one of the tubes in your veins into the heart.
- Through a tube in the leg, a wire is threaded up to the heart under X-ray across your aortic valve. The valve is then ballooned open to make way for the replacement valve.
- Through the same tube a new valve is taken up to the heart over a wire and positioned into place.
- The wires and tubes are removed from your body. A stitching device is used to close the hole in the leg arteries.
The information here is for general reference only. To understand the benefits and risks specific to your condition and overall situation, please discuss the procedure with your treating doctor.
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