What is TAVI?

TAVI stands for transcatheter aortic valve implantation and is a technique to replace a narrowed aortic valve. It is also known as transcatheter aortic valve replacement (TAVR). It is a minimally invasive procedure to replace the aortic valve without the need for open heart surgery, usually via one of the arteries in the groin.

I have been referred for TAVI, what are the next steps?

TAVI requires careful assessment and planning to ensure the treatment is the right option for you, and that the procedure is carried out as safely as possible. The process begins with a consultation to discuss your symptoms and review any investigations that have been done so far. The diagnosis of severe aortic stenosis (a severely narrowed valve) is usually made using a transthoracic echocardiogram, but occasionally other tests are needed. We plan the procedure with a CT scan which will usually be carried out soon after your initial consultation.

How do I know if TAVI is the best option for me?

Once we have completed all the necessary investigations, we will discuss your case in detail at meeting of experts in the management of aortic valve disease (the TAVI multidisciplinary meeting, MDT). This meeting is attended by cardiologists, cardiac surgeons, anaesthetists, radiologists, physicians and nurses with the aim of selecting the right patients for the procedure and carefully planning each step of the procedure to minimise risk. There are generally three options to consider: for many patients, TAVI will be a safe and effective option, for some others, conventional open heart surgery may be the better option and in rare cases the risks of any procedure may be prohibitive and we may recommend management with drug therapy only, though it is important to note that no medication alters the progression or prognosis of aortic stenosis.

What are the benefits and risks?

Aortic valve replacement (whether TAVI or surgical aortic valve replacement) in severe aortic stenosis is likely to result in a symptomatic benefit, improved life expectancy and improved quality of life. TAVI has been shown to offer similar outcomes when compared to surgical aortic valve replacement and a quicker recovery in most patient groups. Some patients notice an improvement in their breathing immediately, and others notice an improvement over the subsequent weeks as they get back to normal activity.The TAVI procedure is not without risk and it is important that you and your family understand these risks. We will give you an idea of the likely risks during your consultation, and once we have the TAVI CT we can give you a more detailed assessment of the risks specific to you. You will have a chance to ask questions about the risks and benefits of the procedure, and information on your procedural risk will be provided both face to face and in writing for you to read after your consultation.

What can I expect from the TAVI procedure?

The TAVI procedure is usually carried out under sedation, but occasionally under general anaesthetic, which will be discussed in advance. Usually we use one of the femoral arteries in the groin to deliver the TAVI valve. The TAVI valve is made of cow or pig heart tissue mounted on a metal stent frame, which is expanded over the existing aortic valve. The procedure takes around an hour. Most patients can expect to be in hospital for around 2-3 nights after the procedure.

What experience does Dr Dawkins have in aortic stenosis and TAVI?

Dr Dawkins trained in TAVI at Cedars Sinai Medical Center in Los Angeles, which is the busiest valve centre in the United States. He gained experience in TAVI in complex situations, such as for patients with previous valve replacement, coronary artery disease and challenging vascular access. He is a high volume TAVI operator and performs around 200 TAVI procedures per year. He chairs the Oxford TAVI MDT and analyses over 300 TAVI CT scans per year to plan TAVI procedures.

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    Dr Dawkins has private clinics in Oxford at the Nuffield Manor Hospital and in London at Cleveland Clinic London. Please get in touch if you would like to make an appointment. We can usually arrange to see you within a few days. For urgent appointments, a same-day visit or telephone consultation can often be arranged. To arrange an appointment, please complete this form or call us on 020 7205 2024 (London) or 01865 598040 (Oxford).