Transcatheter Aortic Valve Implantation: What is TAVI?
February 3, 2025

What is TAVI?
Transcatheter Aortic Valve Implantation(TAVI), known as Transcatheter Aortic Valve Replacement(TAVR), is the most minimally invasive treatment used to treat Aortic Valve Stenosis. Aortic Valve Stenosis is the condition where the aortic valve is narrowed which causes severe restrictions of blood from the heart into the body. This often results in chest pain, shortness of breath, and fatigue.
During the TAVI procedure, a new valve is placed inside the diseased valve without removing the old valve. This treatment requires a small incision (minimally invasive) as opposed to open heart surgery. Most of these individuals experience improvement in symptoms coupled with quality of life. Most people return to their activities within weeks.
What Happens During the Procedure?
During TAVI, a catheter with a replacement valve is introduced into a blood vessel, typically through the groin or under the collarbone. This catheter is then guided inside the heart with the replacement set inside the opening of the diseased aortic valve. The new valve pushes out the old valve and allows the blood to flow through the new valve once it is open. It somewhat replicates what has occurred in the procedure of stent placement within an artery.
These valves are developed to fit and stay in place, some of which expand on their own and others through a balloon to position. Once the new valve is in position, the balloon is deflated, and the catheter is removed.
This procedure is minimally invasive. Patients are awake during the procedure but are often given either local anesthesia with sedation or general anesthesia, depending on what was previously determined. The area is numbed, and patients are made comfortable throughout.
Thus, TAVR is an option for symptomatic patients with severe aortic stenosis, irrespective of whether they belong to a low-, intermediate-, or high-risk group for surgical valve replacement. The minimally invasive nature of TAVI ensures a quicker recovery while successfully rehabilitating normal blood flow.
Risks Of TAVI
Like all treatments, TAVI is not without risks. Even the minimally invasive approach of TAVI carries several risks. Though recovery after the procedure might be faster compared to open-heart surgery, patients should be warned of the following complications:
Bleeding or blood vessel damage: The vessels used for the insertion of catheters may be injured. However, this often is a fixable injury.
Valve problems: In some cases, a paravalvular leak may develop where a leak is caused by a space between the old valve and the replacement valve. In other cases, arrhythmias can cause abnormal heart rhythms and may require the implantation of a pacemaker.
Kidney dysfunction: The dye used for imaging can cause kidney dysfunction, especially in patients with serious pre-existing kidney conditions.
Stroke: There is a small risk of stroke due to clots from debris dislodged during the procedure.
Infection: As with every invasive procedure, infection can be a possible complication.
Blocked coronary artery: The replacement valve may occasionally cause coronary arteries to become obstructed. This is quite rare but possible.
Though rarely occurring, the low risk of fatality depends on the patient’s age and the presence of underlying conditions. Advances in technology and the skills of doctors have decreased much of this risk. An experienced cardiology team evaluates each patient to work through risk factors and decide the best possible treatment.
Post-Implantation Assessment
After the TAVI procedure, a thorough post-implantation assessment is necessary to ensure the success of the implantation and address potential complications.
Aortic Regurgitation
Mild or trivial aortic regurgitation (AR) is a common occurrence after TAVI, but moderate to severe AR can negatively impact patient outcomes and increase mortality risks. Possible causes include:
- Incorrect valve sizing
- Eccentric calcification of the aortic root
- Incomplete valve expansion
To assess the severity of AR, medical professionals use a combination of aortography, echocardiography, and invasive hemodynamic measurements. If AR is deemed significant, corrective measures such as repositioning the valve or post-dilation can be performed to optimize valve function.
Conduction Disturbances
One of the common complications post-TAVI is conduction disturbances, which may necessitate the implantation of a permanent pacemaker. The risk of requiring a pacemaker varies based on the type of prosthetic valve used, with some valves having higher incidences of conduction abnormalities due to their positioning and design. Temporary pacing wires (TPW) are often used during the procedure, and their removal is dependent on the observed conduction stability.
Post-Procedural Care
Following TAVI, patients require specialized post-procedural care to ensure a smooth recovery and prevent complications.
Initial Recovery and Monitoring
Most patients are admitted to a critical care unit immediately after the procedure for close monitoring of vital signs and hemodynamic stability. The duration of critical care stay varies based on factors like procedure complexity, patient frailty, and underlying health conditions. Some patients undergoing uncomplicated transfemoral TAVI under conscious sedation may only require short-term monitoring before being transferred to a general ward.
Hospital Stay and Discharge
Patients are typically transferred to a general ward after their initial recovery, where they undergo further monitoring, medication adjustments, and rehabilitation. The usual hospital stay ranges from 2-3 days, although some patients may require longer stays for additional medical support or rehabilitation. In select cases with minimal complications, same-day discharge has been shown to be feasible.
Medications and Follow-up Care
Post-TAVI, patients are often prescribed:
- Blood thinners (anticoagulants) to prevent blood clots.
- Antibiotics reduce the risk of infection, especially considering the susceptibility of artificial heart valves to bacterial infections.
Regular follow-up appointments with imaging tests are essential to ensure the implanted valve is functioning correctly. Patients are advised to watch for any warning signs of complications, including:
- Dizziness or light-headedness
- Swelling of the ankles
- Sudden weight gain
- Signs of infection at the catheter site (redness, swelling, or drainage)
In cases of severe symptoms such as chest pain, extreme shortness of breath, or fainting, immediate medical attention should be sought.
Conclusion
Although TAVI is a minimally invasive alternative for managing aortic valve stenosis, the risks and complications associated with this procedure must be understood. These risks should be discussed with the healthcare providers for patients to make an informed decision about their treatment options.
The procedure is leading to an improvement in patient outcomes with the current advancement in medical technology. A team of recognized interventional cardiologists, heart surgeons, and heart failure specialists work together as a team to provide state-of-the-art diagnostics and treatments for structural heart conditions.
Frequently Asked Questions
1. Is TAVI safe?
TAVI is generally considered a safe procedure, especially for those who are at risk with traditional surgery. However, with any procedure, there are certain risks, such as bleeding, stroke, valve complications, and infection.
2. How long does the TAVI procedure take?
The procedure usually takes 1-2 hours, but the hospital stay could be about a week or longer, depending on recovery.
3. How effective is TAVI?
TAVI is extremely effective and can greatly improve the quality of life for patients.
4. Can TAVI be performed on elderly patients?
Yes, TAVI can be performed on elderly patients and is often recommended. TAVI is an alternative for open heart surgery and for those who are at risk for open heart surgery.