Finally an alternative to open surgery for patients with high surgery associated risks

  If your aortic valve is severely diseased, you may require replacement of your valve. However you may be advised that an open heart surgery may carry a risk far too high in your case. In this case and if you have the relevant criteria required, you may be eligible to receive an alternative treatment called TAVI (Transcatheter aortic valve implantation). With this novel approach introduced in the UK in 2007, it will be possible to replace your aortic valve without requiring a full open heart surgery.

Who can have a TAVI?

  According to the NICE Interventional Procedure guidance (June 2008) and the device manufacturers approval, the procedure is limited to small numbers of patients who were considered to be at high risk for conventional cardiac surgery. These are patients who will have a scoring on the logistic EUROSCORE questionnaire above 20%.

What is involved with the procedure?

  TAVI is an alternative to open heart surgery and is considered as a minimally invasive approach. This heart surgery can be performed using echocardiographic and fluoroscopic guidance for visualization during implantation.
  During the procedure a valve (Figure 1: a balloon expandable stent combined with a bovine pericardial bioprosthetic tissue valve) is reduced to size and placed on a delivery catheter (Figure 2).

  The delivery catheter is then inserted either in the femoral artery through a small incision at the top of the leg (transfemoral approach) or between the ribs through the apex of the heart (transapical approach).
  Once in the heart, the valve is positioned and deployed across the patient’s diseased aortic valve.

What happens after the operation?

  After a short hospital length of stay, it is possible to be discharged home with a prescription of clopidogrel (for 3 months) and aspirin (for life).

Who can perform TAVI in the UK?

  Only selected accredited centres and teams can perform this procedure.
A list of hospitals is available to you here.

Where can I find more information?

Published early experience with TAVI:
Rodes- Cabau et al, Journal of the american college of cardiology, TAVI for the treatement of severe symptomatic aortic stenosis in patients at very high prohibitive surgical risk; vol 55, 2010 downloaded from here

Walther T, Simon P, Dewey T, Wimmer-Greinecker G, Falk V, Kasimir MT, et al. Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation. 2007;116(11 Suppl):I240-5.

Walther Thomas, Volkmar Falk, Jorg Kempfert, Michael A Borger, Jens Fassl, Michael W A Chu, Gerhard Schuler, Friedrich W Mohr, Transapically minimally invasive aortic valve implantation; the initial 50 patients; Eur Jour of cardio Thor Surgery; June 2008

Webb et al, Transcatheter aortic valve implantation: impact on clinical and valve related outcomes, Circulation 2009, June 1

TAVI Guideline from the National Institute for Health and Clinical Excellence for England and Wales: http://guidance.nice.org.uk/IPG266

European guidelines on TAVI: Vahanian A, Alfieri OR, Al-Attar N, Antunes MJ, Bax J, Cormier B, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2008;34(1):1-8.

Edwards website: Edwards SAPIEN Transcatheter Heart Valve