Transcatheter aortic valve implantation, or TAVI, is a procedure to replace a diseased aortic valve without open-heart surgery. A new valve is delivered through a catheter, most often from the femoral artery in the groin, and deployed inside the existing valve.
Who is suitable
TAVI is approved for patients with severe symptomatic aortic stenosis across the surgical risk spectrum. The decision between TAVI and surgical aortic valve replacement is made by a Heart Team — interventional cardiologists, cardiothoracic surgeons, and imaging specialists working together — taking account of:
- Age and life expectancy
- Anatomy of the aortic root and access vessels
- Comorbidities and frailty
- Patient preference
The procedure
TAVI is usually performed under conscious sedation rather than general anaesthetic, although both options exist. Access is most commonly from the femoral artery; alternative routes are used when the leg arteries are unsuitable. The new valve is positioned under X-ray and echocardiographic guidance and deployed inside the diseased native valve.
The procedure itself usually takes one to two hours. Most patients spend one to two nights in hospital before discharge.
Risks
Although TAVI is less invasive than surgical valve replacement, it is a major procedure with real risks. These include vascular access complications, stroke, the need for a permanent pacemaker, valve leak around the new valve (paravalvular regurgitation), and bleeding. Long-term durability of transcatheter valves continues to be studied. Risks are weighed against the natural history of untreated severe aortic stenosis, which is poor.
Recovery
Most patients are walking within 24 hours and return to normal activities within two to four weeks, faster than after surgical valve replacement. Cardiac rehabilitation is offered to support recovery.