The Leeds Teaching Hospitals NHS Trust


Your condition & treatment


Aortic Stenosis

Aortic stenosis is the term used to describe a severe narrowing of the aortic valve, the main valve through which blood is pumped out of the heart to be supplied to the body. This is a serious condition which causes symptoms of breathlessness, chest pain, dizziness, and blackouts, and which can be, if left untreated, fatal. This condition can be treated by a procedure known as transcatheter aortic valve implantation (TAVI). This website aims to give more information about TAVI as a treatment option.

TAVI

TAVI is a new and high-risk procedure, but has a very high success rate and is effective at treating the problem of the narrowed aortic valve, resulting in a substantial improvement in patients’ quality of life.

Please see below for further information about the TAVI procedure.

Background 

For many years doctors have treated aortic stenosis by replacing the aortic valve using open-heart surgery. This is a well-established and very effective operation. However, in some patients, such as older patients, those with other medical problems, or those who have had previous cardiac surgery, the risks of surgical aortic valve replacement are very high, and the surgeon and patient may decide that the risks are unacceptable.
TAVI allows the aortic valve to be replaced without the need for open-heart surgery, and is therefore a good option for patients in whom the risks of open-heart surgery are unacceptably high.

 

What does the procedure involve?  

Transcatheter aortic valve implantation is usually performed under a general anaesthetic, though can be performed under local anaesthetic with sedation. Your doctors will tell you which approach they plan to use for you.
Tubes are then passed into the arteries and veins in your groin. Through one of these tubes the doctors pass a large balloon into the aortic valve and inflate the balloon to stretch open the narrowed valve. A long tube or ‘delivery sheath’ is then passed through the artery in the groin and up to the heart. The new aortic valve is contained within this tube.
The valve is a ‘tissue valve’ made out of the lining of a pig’s heart and then sewn into a metal tubular frame. The delivery sheath is passed across the aortic valve, and then pulled back to deliver the new valve. The metal tubular frame containing the valve expands of its own accord, pushing your old valve out of the way, and allowing the new valve to start working immediately.
After the procedure you will spend the first 48 hours on the coronary care unit, after which you will be transferred to the ward. You will be discharged home about 5-7 days after the procedure.

The benefits and risks 

The chance of a successful procedure, in other words the valve is successfully replaced and the new valve functions well, is very high, around 95%. After a successful procedure your symptoms will be considerably improved. In most patients previously severe symptoms (of breathlessness and/or chest pain, and/or dizziness and blackouts) are either abolished completely or are only mild after the procedure. This results in a considerable improvement in exercise capacity and quality of life.

 

Is TAVI an established procedure? 

No. Transcatheter valve implantation is a relatively new procedure. It was first performed in 2002. The first procedure in the United Kingdom was undertaken in 2007. The first procedures in the Yorkshire Heart Centre in Leeds were undertaken in May 2008. The evidence that this is an effective and safe procedure is therefore limited to a relatively small number of patients, and no information about long-term outcome after this procedure is available yet. However, the procedure is being performed increasingly frequently. More than twenty thousand patients have now been treated worldwide.

Are there any alternatives?

The alternative options are to undergo aortic valve replacement by open heart surgery, or to continue with drug treatment alone.

Surgical aortic valve replacement is a well-established and very effective procedure, but which carries a high risk in some patients. Your case has been discussed by two Consultant Cardiologists and a Consultant Cardiac Surgeon who specialises in open-heart surgery, and, after discussion with you, the doctors have concluded that the risks of surgical aortic valve replacement would be very high, and that percutaneous aortic valve replacement is a better option.

Drug treatment can sometimes help the symptoms caused by the narrowed aortic valve. However, the effectiveness of drug treatment alone is limited. Without a procedure to replace the narrowed valve your symptoms are likely to remain very troublesome, and indeed to deteriorate over the months to come. Without definitive treatment the condition is usually fatal.

The alternative options are to undergo aortic valve replacement by open heart surgery, or to continue with drug treatment alone.

Surgical aortic valve replacement is a well-established and very effective procedure, but which carries a high risk in some patients. Your case has been discussed by two Consultant Cardiologists and a Consultant Cardiac Surgeon who specialises in open-heart surgery, and, after discussion with you, the doctors have concluded that the risks of surgical aortic valve replacement would be very high, and that percutaneous aortic valve replacement is a better option.

Drug treatment can sometimes help the symptoms caused by the narrowed aortic valve. However, the effectiveness of drug treatment alone is limited. Without a procedure to replace the narrowed valve your symptoms are likely to remain very troublesome, and indeed to deteriorate over the months to come. Without definitive treatment the condition is usually fatal.

 

Post-procedure rehabilitation advice 

Recovery

Time taken to completely recover will vary from patient to patient. On average it will be at least 2-4weeks for recovery from the procedure. Some patients will take longer and some less.

Subclavian TAVI - Wound Care

Your dressing should be removed before you go home. If the wound is clean and dry, you need not have the wound redressed.

You will have some stitches which are dissolvable and therefore do not need removing.

Please look at your wound daily in a mirror. Please report any extra swelling, redness, oozing of wound, hotness to touch and/or excessive pain to the TAVI nurse using the contact number below.

Transfemoral TAVI - Groin care

During your procedure tubes will have been inserted into both groins. These will be removed after the procedure. There will be bruising, therefore it is important to check for swelling or bleeding. If this occurs contact the ward you were discharged from immediately. Inform your GP if you notice any of the following:

Raised temperature or fever

A hard tender lump under the skin around the area of incision (a very tiny, pea-sized lump is normal)

Any increased pain, swelling, redness and/or discharge at the groin site A cold hand or foot on the same side as the procedure In the unlikely event that your groin starts to bleed you should lie down. Apply pressure to the area keeping your or leg (or arm, if the incision was made here) as straight as possible. If bleeding does not stop after 10 minutes you must seek immediate medical attentionIt is important to remember you will have stitches in your groin and these should be removed after 5-7 days. If you have any concerns please speak to your practice nurse.

Driving

It is recommended not to drive for 4 weeks post procedure. If you drive you do not need to inform the DVLA about your procedure. We do advise you to tell your insurance company to avoid problems with any claims you make in the future. If you have problems with your insurance the British Heart Foundation (BHF) will be able to give you details of insurance companies on 0845 070 8070. If you hold a commercial licence you will need to inform the DVLA who will advise you further.

Emotion

If you experience any problems either physically or emotionally post-procedure it is important to mention these to your GP so that he/she can monitor them.

Flying

It is best not to fly for 4 weeks post-procedure, but get advice from your consultant.

Exercise

Gradual re-introduction of exercise after discharge from hospital. For the first week walking around the house only, or perhaps short walks out of the house. After the first week out of hospital aim to gradually increase exercise by walking only. More vigorous exercise than walking should be left for at least 4 weeks post-procedure

Follow-up

Follow-up of your procedure at Leeds will involve:

You will be followed up in the outpatient clinic by the TAVI Nurse Specialist Tracey Ware 6-8 weeks post procedure. We will arrange for you to have a transthoracic echocardiogram on the same day as your outpatient appointment. If you do not have a pacemaker you will need to have a 24 hour ECG monitor fitted once you are back at home. For non Leeds patients this can be done at your local hospital.