TAVI for aortic stenosis
If you have aortic stenosis, a new valve can be put inside the narrowed valve in your heart. This is called a TAVI and can improve how well your heart works, and help your symptoms.
You'll need to have some tests to check that TAVI is the most appropriate treatment for you.
These tests might be carried out in one day during a hospital visit, over several days, or be completed over a series of hospital appointments.
Having tests to check that your heart and blood vessels are suitable is called the TAVI assessment.
If the assessment shows that TAVI is the best treatment for you, a member of your heart team will contact you with the details of your hospital appointment for the TAVI procedure.
Preparing for the TAVI assessment
- Keep taking your usual medicines.
- Tell your heart team about any medicines you are taking before your assessment, including antibiotics.
- Tell your heart team if you are taking blood thinning medicine (such as warfarin, apixaban, rivaroxaban, edoxaban or dabigatran), as these might need to be changed or stopped for a short time before your assessment.
- Tell your heart team if you take metformin, as this medicine might need to be changed or stopped for a short time before your assessment.
- Bring all your medicines to your assessment appointment, including any prescription medicines, or medicines you buy from a pharmacy or shop (including alternative medicines, such as herbal remedies).
Your heart team will talk to you about your medicines and any action you need to take before your TAVI assessment.
You will need some or all of the following tests or investigations during a TAVI assessment.
- Review by your heart team consultant.
- Blood tests.
- Electrocardiogram (ECG), which measures your heart rhythm.
- Echocardiogram, a cardiac ultrasound.
- CT scan.
- Coronary angiogram, to provide a series of X-ray pictures of the arteries surrounding your heart.
- Trans-oesophageal echocardiogram (TOE), a cardiac ultrasound that takes detailed pictures of your heart from your throat.
Depending on what the above tests show, you might need more tests. These can include a chest X-rays or breathing tests. Your heart team will explain these to you if they are needed.
Pain during a TAVI assessment
You might feel some discomfort during the coronary angiogram. During this test a small tube (cathether) is passed into an artery in your groin or wrist, so a contrast dye injection can be used for the scan. You will be given local anaesthetic at the site where the catheter is put in. This might sting at first, but will then numb the area to make it more comfortable during the coronary angiogram.
If you have a trans-oesophageal echocardiogram (TOE) you might feel some discomfort, but should not be painful. You might have a sore throat or hoarse voice afterwards, but these side effects should pass within a couple of days.
Speak to your heart team if you have any questions or concerns about the tests.
Risks of a TAVI assessment
The tests used for the assessment have some risks, though these are relatively small. Most people (about 99 out of 100) will have no major problems.
It's important to be aware of the potential complications of the assessment before you give us your permission to do the tests.
- If you have an angiogram, there's a risk of bruising at the top of the leg where the tube was put in. This happens in about 1 in every 20 people. This can be uncomfortable and might take a few weeks to disappear.
- If you have an angiogram, there is also a risk of damage to the artery in the groin or wrist. This causes a swelling known as a ‘false aneurysm’. It happens to less than 1 in every 100 people, but it could mean you need to stay in hospital for longer for extra monitoring. Some people need minor surgery.
- If your test involves an X-ray with contrast dye, there is a risk of an allergic reaction to the dye. This occurs in less than 1 in every 500 people.
It is important to tell your heart team if you have had any previous allergic reactions before your angiogram or CT scan. If you do have an allergic reaction, we will treat it with medicines.
Giving your permission (consent)
We want to involve you in decisions about your care and treatment. If you decide to have the assessment, you will be asked to sign a consent form. Your heart team will explain all the risks, benefits and other options before they ask you to sign. The consent form states that you agree to have the assessment and understand what it involves.
We will only arrange tests that are needed, but it is your decision if you have them. Your wishes will be respected at all times. Please ask a member of staff if you would like to read our consent policy.
Going home after your tests
There will be different instructions for you to follow depending on what tests you have had.
For example, if you have had an angiogram and you go home on the same day, you must have a responsible adult to help you home. You cannot drive yourself home, but you can be a passenger in a car. You will also need to follow instructions on looking after your wound at home.
Your heart team will give you full instructions. If you have any questions or concerns, please speak to a member of your team before you leave the hospital.
TAVI assessment results
Your results will be discussed at the TAVI multi-disciplinary team (MDT) meeting. These meetings include an experienced team of cardiologists, cardiac surgeons and specialist nurses. They will talk about your results and decide on the best treatment plan for you.
Please be aware it can take a little while to gather the information before your case can be discussed.
After the meeting, your heart team will let you know about your proposed treatment and care plan by telephone or letter. Please be reassured that you will be contacted.
When we contact you, it might be to recommend TAVI, or other treatment options. The assessment tests might show that you need to be referred to another team, for example for an assessment for surgery. Your heart team will talk you through your results and explain any investigations or procedures needed.
If you can have the TAVI procedure
If your test results show you can have a TAVI, a member of your heart team will contact you with the details of when you should come to the hospital.