TAVI

The following diagnostic tests may be performed before a TAVI procedure:

1. Physical examination: The doctor examines the symptoms of the patient. A heart murmur sound (a whooshing sound) heard with a stethoscope may indicate an aortic valve condition. The medical history and family history of the patient are also noted.
2. Echocardiogram: Sound waves are used to obtain the images of the heart in motion in this type of imaging test. It helps the doctor in identifying a weakened heart muscle and determining the severity of aortic valve stenosis.
3. Transesophageal echocardiogram: This test involves the use of a flexible tube containing a transducer that is guided down the throat into the esophagus.
4. Electrocardiogram or ECG: This is a painless test performed to record the electrical activity of the heart by attaching small sensors, known as electrodes, to the chest, arms, and legs region. It helps in detecting heart diseases, abnormal heart rhythms, and enlarged chambers of the heart.
5. Chest x-ray: It helps the doctor in checking if the heart is enlarged, which is a sign of aortic valve stenosis. The x-ray also shows if there is calcium buildup on the aortic valve and swelling of the aorta.
6. Stress test: This test helps the doctor in determining whether the symptoms of aortic valve disease occur during physical activity or by use of certain medications.
7. Cardiac computerized tomography (CT) scan: This is an imaging test done to obtain clear images of the heart. It is used to measure the aorta size and have a closer look at the aortic valve.
8. Cardiac MRI scan: This imaging test makes use of a strong magnetic field and radio waves to create detailed images of the heart. This test is used to determine the severity of the condition and evaluate the aorta size.
9. Cardiac catheterization: The doctor threads a thin, flexible tube known as a catheter through a blood vessel in the arm or groin area and guides it to an artery in the heart. Sometimes, a dye may be injected to make the arteries clearer in an x-ray. This test is done to check that the arteries that feed the heart muscles, known as coronary arteries, are not blocked.

• The procedure is either performed under local anesthesia (the area of operation is numbed) or general anesthesia (the patient is put to sleep during the procedure).
• The doctor inserts a balloon catheter into an artery either in the groin area or underneath the collarbone after making a small incision (cut) in that area.
• This balloon catheter is then guided into the heart and positioned within the aortic valve opening.
• Its position is confirmed using an echocardiogram or moving x-ray images.
• Once its position is confirmed, the doctor will gently inflate the balloon to open up the valve.
• A new biological tissue valve (made up of pig or cow heart tissue) is then implanted by the doctor using a metal mesh tube which helps in keeping the valve in its place.
• The new valve will either expand by itself or the doctor expands it using the balloon.
• The new valve is usually positioned in a way that it pushes aside the damaged aortic valve.
• The balloon is then deflated and the balloon catheter is removed.

The following risks are associated with a TAVI procedure:

• Bleeding
• Complications associated with the blood vessels
• Stroke (a condition of interrupted blood supply to the brain)
• Kidney disease
• Heart attack
• Infection
• Arrhythmias (irregular heart rhythm)
• Need for a pacemaker (a device implanted in the heart to correct arrhythmia)
• Slipping out of the replacement valve
• Aortic regurgitation (leaking of the aortic valve)
• Death

• You will most likely spend the night in the intensive care unit (ICU) for monitoring after the procedure.
• Your stay in the hospital will depend on several factors, including the severity of the condition. Some people may be able to go home on the next day of the procedure.
• You may be prescribed blood-thinners, also known as anticoagulants, by the doctor to prevent blood clots.
• The doctor may also prescribe antibiotics to prevent bacterial valve infections that usually come from bacteria in the mouth.
• You will be told to maintain excellent dental hygiene and routine dental clean-ups by the dentist to prevent bacterial infections.
• The doctor will explain how to take care of the incisions and to look for signs of infection.
• Regular checkups by the doctor and imaging tests are needed after the TAVI procedure to ensure that the new valve is working well.

Visit your doctor immediately if you have any of the following symptoms after the procedure:

• Dizziness
• Light-headedness
• Sudden gain of weight
• Swelling of the ankles
• Severe tiredness
• Symptoms of infection, like fever, redness, increased pain, swelling, drainage at the incision site
• Chest pain, tightness, or pressure
• Fainting
• Shortness of breath