You may have heard of a TAVI procedure. Perhaps you, or someone close to you, has even been recommended they have the procedure done. It can feel overwhelming to hear, and you’ve no doubt got a few questions.
Firstly, you may have wondered what a TAVI procedure is? TAVI stands for Transcatheter Aortic Valve Implantation, which won’t mean much to those outside of the medical profession. But in short, it is a minimally invasive procedure to fix a damaged aortic valve. During a TAVI procedure, an artificial valve will be implanted into your heart.
It’s a procedure that Dr Sonny Palmer from St Vincent’s Private Hospital has been performing since 2014 and it has come a long way over the last 10 years.
Why would I need a TAVI?
There are four main valves in your heart – the aortic valve being one of them. As your heart beats, the aortic valve opens and closes, allowing blood to flow from your heart to the rest of your body in one direction.
As you age, calcium can build up on the valve, making it harder and thicker. As a result, your aortic valve becomes unable to open properly, forcing the heart to work harder to pump blood through the narrowed valve. It can also create high blood pressure inside the left ventricle. This is a condition called Aortic Stenosis.
As Dr. Palmer explains, “Aortic Stenosis is the most prevalent heart valve condition in the Developed World. It affects about 3% of people over the age of 75. Most of my patients are in their 80s and up until recently TAVI was only offered to those patients who were not fit enough or were deemed high risk for an open-heart operation (aortic valve replacement). The evidence is constantly evolving. What is exciting is that in the near future, we may be able to offer this procedure to younger and fitter people.”
Are you at risk of Aortic Stenosis?
Aortic Stenosis is typically a condition of old age, and one that develops over many years. However, when asked of the factors that can lead to developing the condition and what we can do to avoid it, unfortunately the answers are not as easy to come by.
As Dr. Palmer replied, “That’s a great question, I wish I knew the answers. What we know is that the condition causes the valve to become thickened and calcified. Over time this progresses and the valve becomes thicker and stiffer. Eventually normal motion of the valve leaflets becomes reduced. At some point blood is not able to get out of the heart as easy and people develop symptoms. People usually present with breathlessness, chest discomfort and/or dizziness or blackout.”
What does ‘minimally invasive’ really mean?
It can be difficult to imagine any procedure involving the heart as being ‘minimally invasive’. Yet, as Dr. Palmer pointed out, approximately 90% of TAVI procedures are performed using the femoral artery as the access point to deliver the new valve.
Minimally invasive surgery helps to give you a better chance of recovering quicker after your surgery.
What happens during a TAVI procedure?
This involves delivering the new valve through the leg artery. It requires an incision as small as 6mm, and involves passing a small wire through the main blood vessel of the body and into the heart. This wire then acts as a guide to put the new valve in position, in a procedure that Dr. Palmer describes as “pretty simple really!”
The procedure will take place in the cath lab which is like an operating theatre, and you are usually awake throughout your procedure – however the anaesthetist or cardiologist will give you medication to help you relax.
When should I see a doctor?
Of course, if you ever have any concerns, please see a doctor – particularly if you develop any symptoms that may suggest aortic valve stenosis.
Dr. Palmer explained what typically occurs when a patient is referred to him: “A special team of doctors and nurses review your history and investigations to date. There are usually a few investigations needed before we can advise about what to do next, such as an ultrasound of the heart (an echo), a coronary angiogram to look at the arteries of the heart and a CT scan to allow us to determine whether you are technically suitable for TAVI.”
“Based on your medical history and these tests we provide an opinion on whether your valve needs fixing, whether your heart arteries need fixing and actually if an operation is the best thing for you. If we think you are suitable for an operation, we then talk about the preferred approach in your case”.
Dr Sonny Palmer is a Clinical and Interventional Cardiologist at St Vincent’s Hospital Melbourne and St Vincent’s Private Hospital Melbourne. He also provides a Cardiology outreach service in the Gippsland region (Sale). Sonny’s clinical interests include assessment and management of cardiovascular risk, coronary artery disease and valcular heart disease.
Mr Palmer’s Melbourne consulting room is located at:
100 Victoria Parade
East Melbourne VIC 3002
Phone: (03) 5144 4555
Fax: (03) 5144 7564