Transcatheter Aortic Valve Implantation

What is a TAVI?

Transcatheter Aortic Valve Implantation (TAVI), is a procedure whereby a new aortic valve is implanted in patients suffering from “aortic stenosis” – severe narrowing of the aortic valve. It was first performed in 2012, though there have now been over 250,000 cases performed worldwide. This procedure uses the latest in medical technology and minimally invasive techniques to provide an alternative in some patients who are higher risk or not suitable for open heart surgery.

Why do I need a TAVI?

If you are too high risk for surgery, but have a problem with your aortic valve that means it needs to be replaced, you may be a candidate for the TAVI procedure.

The aortic valve is the one of the four valves in the human heart, and probably its most important. It is the last valve that blood flows through before leaving your heart via the aorta, which is the major artery delivering blood to the rest of the body. It normally consists of three thin leaflets which open wide when the left ventricle pumps, and then close again, ensuring blood flows around your body in one direction

With aging, and sometimes other diseases, the aortic valve leaflets can become thickened and infiltrated with calcium, causing them not to open wide when the heart pumps. This disease is called aortic stenosis.

Aortic stenosis restricts the flow of blood and forces the heart to pump harder, putting a stress on the heart and eventually leading to very debilitating symptoms which can include shortness of breath, chest pain, fatigue and dizziness.

It is the most common degenerative disease affecting the human heart valves. However it is also commonly missed, especially in elderly patients, because the early symptoms are attributed to old age.

The diagram below shows the direction of blood flow through your heart valves

What happens during a TAVI?

During the TAVI procedure, a catheter is inserted through a small incision into an artery to deliver the replacement valve to your heart. The new valve is placed and then expanded to its full size and begins functioning immediately.

An uncomplicated procedure takes around one hour by an experienced operator. They can even be done under local anaesthesia. Most patients only need to stay in hospital for 1-3 days, without the need for strong blood thinners such as warfarin.

What are the risks of a TAVI?

Currently TAVIs are typically performed in “medium to high risk” patients, as an alternative to surgery. As with any procedure, there are some risks, including the possibility of:

• Bleeding or injury to blood vessels
• Arrhythmias – sometimes requiring pacemaker
• Obstructed coronary artery
• Aortic regurgitation
• Damage to kidneys
• Stroke
• Death

Your doctor will discuss these with you during your consultation, prior to your procedure.

What is the future of TAVI?

TAVI represents one of the most exciting developments in interventional cardiology, offering a viable alternative to surgery in cases of severe aortic stenosis. It also heralds the start of other minimally invasive procedures to treat diseases in the other heart valves.

How do I find out more?

Information about TAVI can be found on our website HeartStructureClinic.com.au or your doctor can refer you through to our service. Contact details are available on that page, or we can accept queries on HeartStructure@perthcardio.com.au

Dr Michael Muhlmann is an interventional and general cardiologist with public posts at SCGH and Joondalup. He has dual sub-specialities in Echo and Interventional Cardiology.

He specialises in complex angioplasty, percutaneous closure of PFO/ASD and percutaneous management of mitral and aortic valve disease including Transcatheter Aortic Valve Implantation (TAVI). He is an expert in radial artery approach for coronary angiography and angioplasty which has been shown to improve patient outcomes and comfort.

Michael graduated medicine from University of Western Australia. He underwent his cardiology training and then completed a Fellowship in Echocardiology/Heart Failure at Alfred Hospital in Melbourne. He then completed an Interventional Fellowship at John Radcliffe Hospital, Oxford, England which is one of the premier teaching hospitals in the UK.

He then completed an Interventional/Structural Heart Fellowship at London Chest Hospital in East London.

Dr Muhlmann is a Consultant Cardiologist and Interventional Cardiologist at Sir Charles Gairdner Hospital, Hollywood Specialist Centre and Joondalup Health Campus. He was previously the Director of Cardiac Invasive Labs at Sir Charles Gairdner Hospital.

He currently consults from our Nedlands, Mount Lawley and Perth (Mount Medical Centre) rooms.