• Reference Number: HEY1245/2021
• Departments: Cardiology
• Last Updated: 16 July 2021

Introduction

This leaflet has been produced to give you general information about your condition and treatment.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor or specialist nurse, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a transcatheter aortic valve implantation (TAVI)?

You have probably been troubled by some symptoms related to your aortic stenosis (narrowed heart valve) and following discussion with your doctor, they have advised that the best course of treatment would be to have a Transcatheter Aortic Valve Implantation (TAVI).

After a successful procedure your symptoms and quality of life will be considerably improved.

This involves having an artificial heart valve inserted into the narrowed valve using a balloon catheter in order to widen the valve. The valve will consist of a metal framework (stent) and the outer lining of a pig or cow heart. The procedure is usually carried out under local anaesthetic so you will be awake throughout.  The heart does not need to be stopped during the procedure.

The valve will be passed through your veins and arteries to reach your heart, and there are 2 approaches to this:

2. Trans femoral Approach – the guide wire will be passed through the main artery in your groin which will lead up to the heart.
3. Alternate Approach – may be necessary but this will be discussed by your cardiologist before the procedure.

The TAVI team will assess you and your condition with screening tests prior to the procedure, and they will decide which approach would be most appropriate to be used for you.  The TAVI nurse is available to answer any questions you may have regarding your procedure.

Why do I need a TAVI?

You have been diagnosed with a condition called Aortic Stenosis (AS), when the aortic valve is narrowed. When your heart pumps blood it passes through the aortic valve out of the left ventricle in order to reach the rest of your body. When the aortic valve becomes narrowed the blood is not able to leave the heart as effectively, so you may experience symptoms such as chest pain, shortness of breath and dizziness or fainting. It can also affect how well your heart pumps, which leads to the muscle becoming weaker which leads to fluid in the lungs or around the ankles.

The conventional way to treat aortic stenosis is for an aortic valve replacement, which involves open heart surgery to replace the narrowed heart valve with a new synthetic one. It may be due to your overall health and medical conditions that you have been considered for a TAVI procedure as an alternative, your specialist nurse can explain this further. Alternatively, your symptoms can be managed with medication, but this would not treat the aortic stenosis and your symptoms would progress over time as the valve would continue to narrow.

Can there be any complications or risks?

As with every invasive procedure there are risks associated and your cardiologist and nurse will discuss these with you. These include:

• Heart attack
• Stroke
• Death during the procedure
• Requiring a permanent pacemaker following the procedure
• Bleeding or damage to arteries when inserting the guide wires
• Infection
• Kidney Injury – more likely if you already have pre-existing kidney disease
• The need for emergency open heart surgery

How do I prepare for a TAVI?

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following the procedure.

Before you are offered a TAVI procedure you will need to undergo a series of screening tests in order to check you are suitable for the procedure. These tests include:

• A physical examination – listening to your heart and lungs, checking your heart rate and blood pressure
• Further imaging such as a CT scan or MRI scan
• An ECG (an electrical tracing of your heart)
• A chest X-ray
• Blood tests
• An echocardiogram – an ultrasound probe is placed on your chest to capture pictures of your heart and how the valves are working.  You may also require a transoesophageal ECHO where you have to swallow an ultrasound probe under sedation. This will only be required if clearer pictures of your heart are needed.
• An angiogram – passing a tube into your wrist or groin arteries to assess your coronary (heart) arteries, your aorta (the main blood vessel running through the body) and the groin arteries

When you have had all the screening tests done the TAVI team will assess all your results and will decide what the best options for you are. If you are considered suitable you will be invited for the procedure and given a date to attend the hospital for your admission following a pre-assessment visit for final health checks.

What will happen?

Your appointment letter will include details of your admission and what to do when you are admitted. You will be admitted onto a ward at Castle Hill Hospital the afternoon prior to your procedure in order to get you prepared.

You will be kept nil by mouth from the early hours of the procedure, so this means you will not be able to eat or drink until after your procedure. Typically, your procedure will be done under local anaesthetic, but in some cases your TAVI team may decide a better option for you would be to do the procedure under general anaesthetic.

In the Cath Lab

• You will need to lay flat for the procedure. You can have 1 pillow but it is important to keep still.
• Pain – you will have some intravenous paracetamol at the start of the procedure. There may be times when passing the tube, the pain is worse but you will be able to have strong pain relief medication if necessary. You must say if the pain is too much.
• Valve deployment – for the valve to be deployed we will use a pacing wire to make the heart beat very fast and the blood pressure to be lowered to stop the valve from being moved. This may make you feel unwell and dizzy and may even pass out briefly. Be reassured that it is a controlled environment and can quickly be reversed.

Aftercare

• Flat bed rest for one hour, then if the groin site is satisfactory you can sit up 45 degrees. You should be mobile after 3 hrs if all is satisfactory.
• Heart rate needs to be monitored for at least 72 hours if you have a pacemaker may go home sooner
• Discharge will depend on how the wound sites heal and heart rate and rhythm

What will happen afterwards?

Following the procedure, you will spend between 3 to 5 days in hospital recuperating on the ward and when your doctor is happy with your progress they will discharge you home. Some general points regarding your recovery include:

• Physical activity – you should avoid any strenuous activity for 6 weeks following your procedure. You may feel drained for a few weeks after the procedure, but should aim to go for a short walk each day, which can gradually be increased throughout your recovery. Your specialist nurse will discuss your activity if alternate access was used.

• Wound care – your wounds should only be small, so they should be almost healed by the time you leave hospital. If you do still require a dressing then it could be organised with either your district nurse or practice nurse to do this. You may also notice some bruising in your groin, which is normal. You may develop a hematoma, which is a hard lump under the skin due to a buildup of blood, you should contact your doctor if this gets bigger or painful.

• Medications – you may be kept on the remainder of the same medications as before your procedure. If you are not already on blood thinning medications, you will be started on aspirin.

• Driving – you should refrain from driving for 4 weeks following your procedure. There is no need to inform the DVLA of your procedure but it is advisable you declare it to your insurance providers.

• Work – you should be able to return to work 4 to 6 weeks following your procedure.

• Follow-up appointments – a copy of your discharge paperwork will be sent to your doctor with details of your procedure and medications. You will be seen by the cardiologist 6 weeks after your procedure, and you will have an ECHO done on this appointment. Further follow up will be decided by your doctor at this point. 

• The TAVI nurse will also keep in regular contact with you

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Cardiology Department (01482) 461647. E mail – cardiologynursepractitioners@nhs.net

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.