TAVI: transcatheter aortic valve implantation explained
A new aortic valve delivered through a blood vessel rather than by open surgery. Who it may suit, what it involves and what recovery looks like.
In short
Transcatheter aortic valve implantation, or TAVI, treats severe aortic stenosis by delivering a replacement valve through a blood vessel, usually in the groin, and expanding it inside the diseased valve. The chest is not opened and the heart is not stopped. It was developed for patients at high surgical risk and is now also used in selected intermediate and lower-risk patients. Whether TAVI or surgery is more appropriate depends on age, anatomy, other medical conditions and individual priorities, and the decision is made by a specialist heart team.
Severe aortic stenosis that causes fainting, chest pain on exertion or breathlessness at rest needs prompt specialist assessment. Call 999 for fainting, severe chest pain or severe breathlessness.
Key facts
- TAVI treats aortic stenosis, the narrowing of the valve between the heart and the main artery of the body.
- The valve is delivered through a blood vessel, most often in the groin, without opening the chest.
- The choice between TAVI and surgical replacement is made by a heart team, taking account of age, anatomy and other conditions.
The problem TAVI treats
The aortic valve sits between the main pumping chamber and the aorta, the large artery carrying blood to the body. With age it can become thickened and calcified so that it no longer opens fully. This is aortic stenosis, and it is the most common valve condition requiring treatment in older adults.
The heart compensates by thickening its muscle, and for years there may be no symptoms. Once breathlessness, chest tightness on exertion or fainting appear in severe stenosis, the outlook without treatment is poor, and this is why symptoms in known aortic stenosis are treated as an important development. There is no medication that reverses the narrowing; the valve has to be replaced.
How the procedure works
A catheter carrying a collapsed replacement valve, mounted on a metal frame, is advanced through a blood vessel, most often the femoral artery in the groin. Where those vessels are unsuitable, other access routes are available. Under X-ray and echocardiographic guidance, the new valve is positioned within the diseased one and expanded, pushing the old leaflets aside and taking over their function immediately.
The chest is not opened and the heart is not stopped. Most procedures are performed under local anaesthetic with sedation rather than general anaesthesia, which is part of why recovery tends to be quicker.
Assessment beforehand
Preparation is detailed, because sizing and access route must be exact. It normally includes echocardiography to confirm severity, a CT scan of the heart and the vessels to measure the valve and assess the arteries, coronary assessment, an ECG, blood tests and a general evaluation of fitness and frailty.
The results are reviewed by a heart team comprising interventional cardiologists, cardiac surgeons, imaging specialists and anaesthetists. That team considers whether intervention is appropriate at all, and if so whether TAVI or surgical replacement is the better option for you.
Recovery and what follows
Most patients are monitored closely for the first day, with heart rhythm watched carefully. Hospital stay is commonly 1 day or 2, considerably shorter than open heart surgery. Return to normal activity is correspondingly quicker.
Follow-up includes echocardiography to check the new valve is functioning well, attention to medication, and dental and endocarditis-prevention advice.
Who it may suit
TAVI was introduced for patients considered too high-risk for open surgery. Trial evidence has since supported its use in intermediate and, lower-risk patients. Age, life expectancy, the anatomy of the valve and arteries, other cardiac disease requiring treatment at the same time, and your own view of the trade-offs all contribute to the decision. There is no single right answer that applies to everyone, which is precisely why the discussion is individual.
Sources
This page provides general information and does not replace individual medical advice, diagnosis or emergency care. Decisions about tests and treatment depend on your own history, examination and results.