TAVI for aortic stenosis
If you have aortic stenosis, we can put a new valve inside the narrowed valve in your heart. This procedure is called a TAVI. It can improve how well your heart works and help your symptoms.
You need to have some tests to check that TAVI is the most suitable treatment for you. We might do these tests:
- in 1 day during a hospital visit
- over several days
- 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. They give you 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 that you take before your assessment, including antibiotics.
- Tell your heart team if you take blood-thinning medicine (such as warfarin, apixaban, rivaroxaban, edoxaban or dabigatran). You might need to change or stop this medicine for a short time before your assessment.
- Tell your heart team if you take metformin (a medicine to treat high blood sugar levels). You might need to change or stop this medicine for a short time before your assessment.
- Bring all your medicines to your assessment appointment. This includes prescription medicines and any medicines that you buy from a pharmacy or shop (including alternative medicines, such as herbal remedies).
Your heart team talks to you about your medicines. They explain anything that you need to do before your TAVI assessment.
Tests during the TAVI assessment
You need some or all of these tests or investigations during a TAVI assessment.
- A review by your heart specialist.
- Blood tests.
- An electrocardiogram (ECG), which measures your heart rhythm.
- An echocardiogram, which is an ultrasound scan to look at your heart and nearby blood vessels.
- A CT scan, which uses X-rays and a computer to create detailed pictures of your heart and blood vessels.
- A coronary angiogram, which gives a series of X-ray pictures showing the arteries (blood vessels) around your heart.
- A trans-oesophageal echocardiogram (TOE), which is an ultrasound scan that takes detailed pictures of your heart from your throat.
Depending on what these tests show, you might need more tests. They can include a chest X-ray or breathing tests. Your heart team explains these tests to you if you need them.
Pain during a TAVI assessment
You might feel some discomfort during the coronary angiogram. During this test, we put a small tube (catheter) into an artery in your groin or wrist. This is so that we can inject a contrast dye. The dye makes your arteries show up more clearly on the scan.
We give you a medicine called a local anaesthetic in the area where we put in the catheter. This might sting at first, but then numbs the area and makes you more comfortable during the coronary angiogram.
If you have a trans-oesophageal echocardiogram (TOE), you might feel some discomfort. However, the test should not be painful. You might have a sore throat or hoarse (strained) 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, but these are quite small. Most people (about 99 out of 100) have no major problems.
It's important to know the possible complications before you give us your permission to do the tests.
- If you have a coronary angiogram, there's a risk of bruising at the top of the leg where we put in the tube. This happens to about 1 in every 20 people. It can be uncomfortable and might take a few weeks to disappear.
- If you have a coronary angiogram, there is also a risk of damage to the artery in the groin or wrist. This causes a swelling called a false aneurysm. It happens to less than 1 in every 100 people, but could mean you need to stay in hospital for more 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 affects less than 1 in every 500 people.
Before your coronary angiogram or CT scan, it is important to tell your heart team if you have previously had any allergic reactions. 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 TAVI assessment, we ask you to sign a consent form. Your heart team explains all the risks, benefits and other options before they ask you to sign. The consent form says that you agree to have the assessment and understand what it involves.
We only arrange tests that you need, but it is your decision if you have them. We respect your wishes at all times. Please ask a member of staff if you would like to read our consent policy.
Going home after your tests
There are different instructions for you to follow, depending on what tests you had.
For example, if you had a coronary angiogram and go home on the same day, a responsible adult must help you home. You cannot drive yourself home, but you can be a passenger in a car. It is also important to look after your wound at home.
Your heart team gives 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
We discuss your results at a multi-disciplinary team (MDT) meeting. This meeting includes an experienced team of heart specialists, heart surgeons and specialist nurses. They talk about your results and decide the best treatment plan for you.
Sometimes, it can take a little while to collect the information before we can discuss your case.
After the meeting, your heart team tells you about your proposed treatment and care plan by phone or letter. Please be reassured that we will contact you.
When we contact you, we might recommend a TAVI or other treatment options. The tests might show that we need to refer you to another team. For example, you might need an assessment for surgery.
Your heart team talks to you about your results and explains any more tests or procedures that you need.
If you can have the TAVI procedure
If your test results show that you can have a TAVI, a member of your heart team will contact you. They explain when you need to come to the hospital.