• Reference Number: HEY1521/2025
• Departments: Cardiology
• Last Updated: 31 January 2025

Introduction

This booklet is designed to give you advice and guidance once you go home after your TAVI procedure.

Please read this booklet carefully and keep it to hand during your

rehabilitation process. It contains useful information and advice for patients after your procedure and there is information if you would like to start a formal cardiac rehabilitation programme.

After you have left hospital, you will have:

• 6 week follow up echocardiogram
• 8 week follow up call with a TAVI Specialist Nurse
• 1 year follow up echocardiogram

You will then be referred to your local NHS hospital for yearly surveillance echocardiograms

The aims of Cardiac Rehabilitation are:

1. To give you information on how you may feel after your procedure.
2. To give help and essential support once you go home.
3. Assist you in your recovery following your TAVI
4. Advise you on Healthy Heart lifestyle changes that will benefit your long-term recovery.

As part of your follow up care, you will be referred to your local Cardiac Rehabilitation Centre.

Once the referral is received, it is then triaged which usually takes 3 to 7 days.

An appointment will be offered, and you are able to choose the best option for yourself; face to face or via telephone.

Once consented to exercise you will be referred to phase 3 Cardiac rehabilitation exercise program and the wait time from referral to contact is 4 to 6 weeks.

This booklet will help guide you through the first 1 to 6 weeks after your procedure. At 4 to 5 weeks you may feel well enough to take part in a Cardiac Rehabilitation Programme which involves regular exercise sessions and educational support.

You may still have some questions about your recovery and rehabilitation after you have read through this booklet.

These can be answered during your follow up calls if you have any concerns, in the meantime please contact any of the following:

TAVI Team: tel: 01482 461516

Local Cardiac Rehabilitation team: tel: 01482 247111

What does Cardiac Rehabilitation Programme involve?

Cardiac Rehabilitation is an essential part of your recovery after your TAVI procedure. A Cardiac Rehabilitation Programme is a Cardiac Rehab is education, advice and an exercise program which helps you manage your recovery.

The team consists of a physio team which is made up of band 4,5,6 and 7s.

You will need time to rest when you come out of hospital, which is advisable since you have had a procedure on your heart, and you will need time to adjust. When you feel ready, maybe after a few days of pottering around the house or garden, you should try doing some short walks (Remember to keep to your own pace, taking it slowly at first, doing only what you can). It’s a good idea to take someone with you, to help you feel a bit more confident.

Once assessed by the physio team you will be prescribed a prescription of exercise, based on individual ability.

Face to face program is 8 week program x2 sessions per week; 16 sessions

Home based remote is a 6 week program.

They will continue to set gradual challenges depending on your individual recovery. The programme itself will take place in a local hospital or community venue. Here, you will be attending alongside other people, who have undergone similar heart related procedures. You will have the opportunity to use gym equipment or join a class, depending on your limitations and capabilities.

You will also get to meet the Cardiac Rehabilitation Team in person. However, if you feel a social setting is not right for you, or maybe have transport issues, then you will have the added option of taking part in a home programme, with individual telephone guidance and support. Whichever you choose, the programme will help restore your confidence, maximise your recovery and improve your quality of life.

Exercise

The short-term benefits of exercise include:

• Improvements to mood, energy levels and self-confidence.
• Research has also shown exercise reduces anxiety, depression and stress.

Long term benefits include:

• Reduced risk of cardiac events, (for example heart attacks) strokes, cancer and diabetes.
• It can also help to lower blood pressure and cholesterol levels.

Exercise increases the pumping ability of your heart and this in turn will improve circulation around your body. It also improves the efficiency of your muscles to take oxygen from the blood and as a result the heart has to do less work when you are active.

Your recovery is important to us, and we want to make sure you have the right support and information to lead a healthy life. As part of your recovery, you will have the opportunity to attend Healthy Heart sessions, which look at positive lifestyle changes, essential to living a good quality of life.

Each Cardiac Rehabilitation Programme will last around 8 weeks in total, you may be surprised at what you will be able to achieve within that time. We aim to set you on the road to a good recovery, with healthy heart changes which we hope you will continue to use after you have finished your programme.

After you have completed your programme, we will let your GP know about your attendance, recovery and rehabilitation progress.

Recovery in the first few days

Everyone’s recovery is different, and our initial advice is only general, for specific advice you will need to talk to a member of your local rehabilitation team. You may get a little swelling around your ankles after your procedure, this will be fluid retention, raise your legs whenever possible and in time it should go away. If it does not improve, you will need to contact your GP for a review.

Take a shower daily, do not be afraid to get your wounds wet, showering will keep your wounds clean and encourage them to heal. Avoid placing soap directly on to the wound. Do not have a bath for 3 days after your procedure as this can affect the wound. You may find it easier to use a shower rather than a bath, but if you do have a bath remember to:

• Empty the water before you get out and take your time
• Use a non-slip mat or a towel before attempting to stand up
• You may need assistance to help you get out of the bath.

Be careful, take things easy and avoid any strenuous activity in the first 72 hours, this is essential for the wound to heal in your groin. Your wounds should be healed by the time you leave hospital. Any dressings can be taken off after 24 hours.

• If your wound looks red or swollen at any time, you should contact your GP.
• Some people may have a small collection of blood beneath the skin called a haematoma; if it becomes painful or increases in size you should contact your GP.
• Any bruising should go away in a few weeks.
• Take Paracetamol for pain if required.

A summary guide- for the first few weeks at home

Week 1

Exercise is an important part of your recovery, but you should take things easy for your first few days at home. Aim to be as active as you were on your last day in hospital. Remember to have a sleep or a rest when you need it. Try not to push yourself past your limits. Do not do any heavy lifting or carrying for 4 weeks.

Take a short walk with somebody each day (5 to 10 minutes at first) and gradually build the distance up. You may still need some painkillers for this first week – you will find them more effective if you take them regularly, e.g. two 500mg Paracetamol 4 times a day– no more than 8 tablets in a 24 hour period.

You can climb the stairs or walk-up inclines, but you may need to do it more slowly in the early days. It is normal to still feel a bit short of breath, this will start to improve as your fitness level increases.

Week 2 to 3

You should feel able to do more activities around the house. Increase your walking and remember to try to do this each day. Do not get overtired and remember to rest when you need to. You can do light housework. You will find that you will be able to have short visits to the shops for light items.

After your third week post discharge you will usually receive a telephone call from the Cardiac Rehabilitation Nurse.

Remember accept your limitations and do not overtire yourself.

Weeks 3 to 6

You should be able to manage most household tasks, but still avoid heavy gardening. Most patients will feel they are back to normal activities at some point during this period, but it is important to remember that you have had a recent implant procedure on your heart.

It is important that you gradually continue increasing your activities, with regular walking and any additional exercises that have been prescribed for you, after your fitness assessment.

At 6 weeks, as part of your treatment after your procedure you may have the opportunity to take part in a cardiac rehabilitation programme for up to 8 weeks.

Additional Recovery Information

Driving

You cannot legally drive after heart valve implant for 4 weeks from the time of your procedure. You can start driving again after 4 weeks, if you feel well enough to do so and can perform an emergency stop. Remember you must always wear a seatbelt, so it is important to make sure that this is comfortable before you recommence driving.

Provided you have no other disqualifying condition, and you feel well enough to drive, if you hold a car or motorcycle licence, the DVLA do not need to be notified. However, you must inform your insurance company of your TAVI Procedure.

Holders of LGV and PSV licences that have had valve implants cannot drive for 3 months and must inform the DVLA. If you hold one of these licences, you can be fined up to £1,000 if you fail to tell DVLA about a medical condition that affects your driving. It is your responsibility. You may be prosecuted if you’re involved in an accident as a result. The phone number is tel: 0300 7906806 or www.dft.gov.uk/dvla/medical.aspx

Rest, Sleep and Relaxation

During the first few weeks at home you will find that you get tired easily, so getting enough rest and sleep is just as important for your recovery as exercising. Tell your family and friends when you are planning to rest; this will help cut down the amount of disturbance you get during this time. Try to get eight to ten hours sleep each night. You may find it difficult for the first week after leaving hospital, as your usual sleep pattern will have been disturbed. If you have discomfort, ensure you are taking your pain relief. Remember to listen to your body and rest and sleep when you need to.

Moods and Emotions

Immediately after your procedure you may have days when you feel down or depressed, this is known as the “post-op blues” and it is normal to feel this way, so do not worry. You may feel irritable or overly emotional and tearful. This can happen at any time, and without warning. It usually settles down within the first few months. Both you and your family will be affected by these feelings, so it is important that you discuss with them how you are feeling. If you find you are continuing to struggle, while participating in the rehab programme, inform your rehab team.

The team will refer you to your local Lets Talk service (Hull) or IAPT for East Riding Patients. If you start to feel low in mood further into your recovery, for example, after you have finished your rehabilitation programme and are feeling unusually depressed, lacking concentration or experiencing memory loss, you should contact your GP for guidance and support.

Sexual Relations

Many patients that have undergone cardiac surgery/procedures feel anxious about resuming sexual relationships. It is quite safe to have sex and/or sexual stimulation after the procedure. However, we generally advise that you wait between 2 and 4 weeks, to give your wounds a chance to heal. You may resume whenever you feel ready.

Holidays and Flying

You can holiday in this country whenever you feel well enough to travel. If you are thinking of going abroad, we advise you to wait until after your follow-up appointment. If you are thinking of a long-haul flight, then you should leave it longer, but should discuss and agree the best time with your consultant. If you are taking Warfarin, you need to let your anticoagulant clinic know, as they may need to adjust your dose.

You must also inform your holiday insurance company of the details of your procedure.

Dental Visits

People who are at increased risk of infections of the heart valves (a condition called infective endocarditis) may need to take an antibiotic before certain dental or other invasive medical procedures. Taking a pre-procedure antibiotic to prevent infection is called “antibiotic prophylaxis.”

Prophylaxis Against Infective Endocarditis

This patient is considered high risk of an adverse outcome from Infective Endocarditis.

Maintenance of oral hygiene is vital.

Antibiotic Prophylaxis to reduce the risk is recommended prior to major dental procedures in line with ESC/EACTS guidelines.

The patient should discuss this decision with their dentist.

Although Infective Endocarditis is uncommon, it can happen if bacteria get into the bloodstream (for example, during a dental or surgical procedure) and travels to a heart valve.

Anyone who is at risk of developing Infective Endocarditis should follow a program of good oral hygiene and tooth care. This includes a professional cleaning every six months, twice-daily tooth brushing, and daily flossing. These measures can help to prevent plaque and bacteria from building up around the gums and teeth and reduce the risk.

Preventive antibiotics before certain procedures are recommended for people who are at highest risk of adverse outcome from IE, including those with the following conditions:

• A prosthetic heart valve or past valve repair with prosthetic (manufactured) materials
• A prior history of IE
• Certain types of congenital heart disease
• Cardiac transplantation with presence of heart valve abnormalities

Further Information

Scottish Dental guidelines (Aug 2018) suggested that patients in high-risk groups undergoing invasive dental procedures should have their care discussed with their cardiologist and, where the cardiologist recommends it, a shared decision-making discussion should be had between the patient and dentist on the pros and cons.

ESC Guidelines for the management of endocarditis (2023) developed by ESC and endorsed by EACTS and EANM. Recommended in patients at high risk of infective endocarditis undergoing at-risk dental procedures and recommended prophylactic antibiotics regime

Medication

The nurse discharging you will give you a supply of any newly started tablets, which should last at least 4 weeks. This will give you time to get your prescription to your GP ready for your repeat prescription.

As well as your normal medications, you will usually be sent home with additional blood thinning medication. This will be long life medication.

If you have had intracoronary stents in the run up to your TAVI, you will be given advise about continuing blood thinning medication on discharge.

Patients taking anticoagulants will remain on this post procedure.

You may be discharged home on some painkillers, as previously mentioned (such as Paracetamol). We recommend you take these regularly until you are no longer getting discomfort from your wound. Take Paracetamol two 500mg 4 to 6 hourly, as required with no more than 8 tablets in 24 hours.

References

Taking control of your Medicines American Heart Foundation

www.heart.org

Walking for health –NHS www.nhs.uk

www.physiotec.ca

The Trust operates a smoke free policy.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the TAVI Specialist Nurses on tel: 01482 461516.