What Is the TAVI Method? Aortic Valve Replacement Without Surgery

The greatest revolution of the last 15 years in the treatment of aortic valve stenosis has been the TAVI method, which makes valve replacement possible without opening the chest, through a catheter inserted from the groin. In this article I will explain what TAVI is, in whom it is used, and how long it lasts.

How Is TAVI (Transcatheter Aortic Valve Implantation) Performed?

In TAVI, a biological valve in folded form is advanced through a thin catheter, usually inserted through the artery in the groin, into the patient’s own damaged aortic valve, where it is expanded and positioned. The heart is not stopped and the breastbone is not opened; the procedure is mostly completed within 1-2 hours under local anaesthesia and light sedation.

For Whom Is TAVI Suitable? (High-Risk Patients)

When TAVI was first developed, it was designed for patients for whom open surgery carried a very high risk or who were unsuitable for surgery. However, PARTNER 3 and similar large randomised trials have shown that TAVI now gives short-term results similar to, and in some outcomes even better than, open surgery in low-risk patients as well; for this reason we can today consider TAVI in many patient groups with suitable anatomy. The decision is made by the heart team (the cardiologist and the cardiac surgeon assessing together), according to the patient’s age, overall risk profile and the anatomical features of the aortic valve.

How Long Does a TAVI Valve Last?

The valves used in TAVI can also wear out over time, like biological valves; the 5-7 year follow-up data of large studies show that durability follows a course similar to that of biological valves implanted with open surgery. Follow-up studies for longer-term data (10 years and beyond) are ongoing; when the valve wears out, in most patients treatment is possible with another catheter procedure, by placing a new valve inside the old one (valve-in-valve).

Frequently Asked Questions

Is TAVI as effective as surgery? In the appropriate patient group, yes; large randomised trials have shown that TAVI gives short- to medium-term results similar to open surgery, and in some outcomes better.

How soon is a patient discharged after TAVI? In cases without complications we usually discharge our patients within 1-3 days.

Is everyone a candidate for TAVI? No; vascular access, valve anatomy and additional illnesses affect this decision, and the decision is made together with the heart team.

Conclusion

TAVI is a safe and effective method applied with a catheter, without opening the chest, in the treatment of aortic valve stenosis. The assessment of suitability is made on an individual basis by the heart team.

You can book an appointment for a detailed examination to assess whether TAVI is suitable for you for your aortic valve stenosis.

References

1. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019;380(18):1695-1705.
2. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227.