Patient education: Transcatheter aortic valve implantation (The Basics)

What is transcatheter aortic valve implantation? — The aortic valve is 1 of the 4 valves in the heart (figure 1). "Transcatheter aortic valve implantation" ("TAVI") is a procedure to replace the aortic valve. It is also sometimes called "transcatheter aortic valve replacement" ("TAVR").

The aortic valve might need to be replaced if it is not working correctly. Most TAVIs are done to treat aortic stenosis (figure 2). This is a condition in which the aortic valve does not open fully.

TAVI is a "minimally invasive" procedure. With TAVI, the doctor uses small cuts (or "incisions") to reach blood vessels that lead to the aortic valve. You might be able to return to normal activities sooner than if you had open heart surgery.

How do I prepare for TAVI? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests – These include tests to check kidney function and red and white blood cell counts.

●Electrocardiogram ("ECG") (figure 3) – This measures the electrical activity in your heart.

●Echocardiogram ("echo") (figure 4) – This uses sound waves to create images of your heart. The images show how well your aortic valve is opening and closing. This also lets the doctors measure the thickness of the walls of your heart, measure the size of the spaces or "chambers" inside your heart, and see how your heart pumps.

●Chest X-ray, CT scan, or other imaging tests – These let the doctor look carefully at your blood vessels and aortic valve.

●Cardiac catheterization ("cardiac cath") (figure 5) – The doctor puts a thin tube into a blood vessel in your leg or arm. Then, they move the tip of the tube up to your heart to take measurements. Next, the doctor puts a dye into the tube that shows up on X-ray.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●Any prior heart history or other serious illnesses or operations

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during TAVI? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Moderate sedation – This makes you relax and sleepy. With sedation, you might not remember the procedure when it is over. Local anesthesia is used to numb the areas where small incisions will be made.

•General anesthesia – This makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor might place a temporary pacemaker wire, or "lead." A pacemaker is a device used to treat a slow heart rate.

●The doctor will make a very small incision in the top, inner part of your leg. In some cases, they will make the incision somewhere else instead, such as under the collarbone, in the chest, or over an artery in your wrist.

●The doctor will put a plastic tube, called a "catheter," in a blood vessel that is just underneath the incision.

●Then, they will gently push the tube through your blood vessels to your aortic valve (figure 2). You will not be able to feel this.

●While this is happening, the doctor will take X-rays of the tube in your body. This helps them know when the tube has reached the correct place in your heart.

●When the tube is in place, the doctor will insert the new valve through the catheter. They will place the new valve inside of the old one. The old valve is not removed. The new valve expands and pushes the old valve to the sides. The new valve will control the blood flow from your heart.

●The doctor will remove the tube from your body and put pressure on the incision to prevent bleeding. They will cover the incision with a bandage.

●The procedure usually takes about 2 to 4 hours.

What happens after TAVI? — After your procedure, you will be taken to a recovery room or the intensive care unit ("ICU"). The staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●You might need to lie flat for a time after your procedure. This is to make sure that you do not bleed in the area where the catheter was placed.

●The staff will help you get out of bed and start moving around when you can.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods. Your doctor might order a special diet for you.

●You might have to stay in the hospital for 1 or 2 days or longer after your procedure.

What are the risks of TAVI? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Damage to the heart or blood vessels

●Kidney injury

●Infection

●Blood clots or stroke

●The new valve not working

●Heart rhythm problems

●Death

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Transcatheter aortic valve implantation – Discharge instructions (The Basics)
Patient education: Prosthetic valves (The Basics)
Patient education: Aortic stenosis (The Basics)
Patient education: Aortic regurgitation in adults (The Basics)