Transcatheter Aortic Valve Implantation
What is Transcatheter Aortic Valve Implantation?
Transcatheter aortic valve implantation (TAVI) involves inserting a new artificial heart valve inside the old tight valve using a balloon catheter. The valve is made up of a metal frame (stent) and the outer lining (pericardium) of a cow’s heart. The procedure is carried out under general anaesthetic.
Transcatheter Aortic Valve Implantation Techniques
There are two common routes of new valve insertion:
1. Transfemoral - through the femoral artery, the main artery in your groin which leads back to the heart. 2. Transapical - through a small cut on the left side of your chest to get to the apex (tip) of your heart.
The ‘TAVI team’, including your cardiologist, cardiac surgeon and anaesthetist will review your medical condition and screening tests to decide the most appropriate treatment and access route for you.
You will be anaesthetised and then have a drip inserted into your neck and arm and a urinary catheter inserted into your bladder. You will have some tubes put through the blood vessels in your groin to deliver the contrast dye and a pacing wire to speed up the heart during the valve insertion to ensure correct positioning.
The surgeon will gain access making a small incision either in your groin or chest wall. A catheter (narrow tube) is passed from the femoral (groin) artery to the aorta (transfemoral) or through the heart muscle near to the aortic valve (transapical). The catheter allows a balloon to be placed into your tight valve, the balloon is inflated to stretch the valve open. This part of the procedure is called balloon aortic valvuloplasty (BAV).The new valve for implantation will be carefully compressed and mounted onto a balloon delivery catheter. When the valve is in the correct position your heart rate will be increased using the temporary pacing wire for a few seconds.
This reduces the blood pressure and the motion of the heart making the procedure safer.The balloon is then expanded opening up the replacement valve in to a permanent position. The balloon is deflated and removed leaving the new valve to function immediately.The operation site is repaired by the cardiac surgeon. A pleural (chest) drain is inserted if access has been via the transapical route, to drain any excess fluid or air from the chest cavity. The procedure takes one to two hours.