TAVI

TAVI – transcatheter aortic valve implantation – is an advanced procedure in which a team of specially trained consultants replace narrowed heart valves without the need for open heart surgery.

Dr Douglas Muir

When the main valve which allows blood to flow from the heart around the body has become narrowed it can cause chest pain, breathlessness, fainting and, if left untreated, life-threatening heart failure.

The traditional treatment option is to have major open heart surgery, which involves opening up the patient’s chest, stopping their heart and inserting a new artificial heart valve; although this is not always possible for more frail or elderly patients.

TAVI, which has been performed at James Cook since November 2009, is a much less invasive alternative, where patients are fitted with new heart valves through a small cut which is made in their groin or chest. It also dramatically cuts the length of recovery time.

The specialist technique can only be performed at accredited hospitals and involves a number of  consultants for each procedure. Each procedure involves two interventional cardiologists and a cardiac anaesthetist with additional involvement of heart surgeons and imaging cardiologists in some circumstances.

Results from James Cook show the implant has had a 98% success rate with just under 90% of patients being discharged within three days of having the procedure.

All of our TAVI patients have been elderly and have had significant other medical problems. In many cases, open heart surgery would have been impossible or extremely high risk. The majority of patients have found a real benefit in symptoms and general quality of life, which would not have been possible with medication alone.

The procedure involves doctors using advanced scanning and images to insert a thin tube, or catheter, into a small cut made in the groin or chest. This is fed up through the arterial system to where the valve has become narrow. A tiny balloon is then fed up the catheter to the blockage and inflated to stretch the narrowed valve.

After this, the new valve is inserted and expanded by another balloon or through a self expanding mechanism. The new valve is held in place by the surrounding tissues. There is no need to stop the beating heart and if all goes well patients can be up and about within a few hours.

The team at James Cook recently celebrated their 500th TAVI case – click here to read more or click the links to the left to view video feedback from our patients.

When patients first had TAVI in 2009 they would come into hospital the day before, have a general anaesthetic so they would be completely asleep for the procedure and then spend three to five days recovering on the ward.

Eight years on, most patients can now attend on the day, most have a local anaesthetic so they are awake throughout the procedure and the equipment used is more sophisticated. This speeds up recovery and reduces complications – around 60% of TAVI patients now go home the next day.

“Coupled with quick recovery times and improvement in symptoms at follow-up, this has been a very rewarding treatment to provide and it keeps us at the forefront of developing heart services.”

Consultant interventional cardiologist Dr Douglas Muir

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