Transcatheter aortic valve implantation (TAVI)

What is TAVI?

Transcatheter aortic valve implantation (TAVI), also called TAVR, is a keyhole procedure that replaces a severely narrowed aortic valve without open-heart surgery. A new tissue valve, mounted on a collapsible frame, is guided to the heart through a thin tube inserted via a small puncture in the artery at the top of the leg. Positioned inside the diseased valve, it expands and takes over immediately, pushing the old valve leaflets aside and restoring normal blood flow from the heart to the body.

TAVI has transformed the treatment of aortic stenosis: what once required stopping the heart and opening the chest is now routinely performed in one to two hours, often under sedation and local anaesthetic, with most patients home within two to three days.

Why severe aortic stenosis must be treated

Aortic stenosis is the progressive narrowing of the valve between the heart and the body, most often from age-related calcification. The heart compensates silently for years, but once severe stenosis causes symptoms, breathlessness, chest tightness, dizziness or blackouts on exertion, the outlook without valve replacement is poor: on average, survival is measured in a small number of years. No medication can open a calcified valve. Timely replacement, by TAVI or surgery, is the only effective treatment, and it is genuinely life-saving.

If you have been told you have a murmur or valve disease, do not wait for symptoms to become disabling before seeking specialist review.

TAVI or surgery?

Both TAVI and surgical valve replacement are excellent treatments, and the right choice is individual. TAVI is firmly established for patients at higher surgical risk and for most older patients, and trials now support it across a widening range of ages and risk profiles. Surgery retains advantages for some younger patients and for certain anatomies or accompanying problems that need fixing at the same time. Every TAVI decision is made by a specialist heart team, imaging cardiologists, interventionists and surgeons together, and Dr Assomull will ensure your case is presented, and your preferences heard, within London's specialist valve programmes.

Assessment before TAVI

Precise planning is the heart of a good TAVI. Your work-up typically includes an echocardiogram to grade the stenosis, a dedicated cardiac CT to measure the valve and vessels for device sizing, an angiogram or CT coronary angiogram to assess the coronary arteries, and blood tests with an anaesthetic review.

What happens during the procedure?

• Under sedation or general anaesthetic, a fine tube is introduced through a small puncture at the groin.
• The new valve is guided to the heart under X-ray and positioned precisely within the old valve.
• The valve is deployed and its function confirmed immediately on imaging.
• The puncture is closed with a small internal device; there is usually no surgical wound at all.

Recovery is remarkably quick: most people are walking the same evening, home in two to three days, and feel the benefit, breathing freely again, within days to weeks. Light activity resumes almost immediately, with a graded return to full activity over a few weeks.

Results, risks and related procedures

TAVI relieves symptoms and improves survival in severe symptomatic stenosis, with procedural success rates in experienced centres above ninety-five per cent. Risks are carefully managed and include vascular bruising or injury at the groin, the need for a pacemaker where the valve frame presses on the heart's wiring (affecting roughly one in ten patients), and small risks of stroke or leak around the valve, much reduced with modern devices. Where a previously replaced valve degenerates or leaks, valve-in-valve TAVI and paravalvular leak closure offer keyhole solutions, and we will guide you to the right team for these too.

Frequently asked questions

How long does a TAVI valve last?

TAVI valves are made of biological tissue, and durability data now extend beyond ten years with encouraging results, broadly comparable to surgical tissue valves. Should a valve wear over time, a further valve can often be implanted inside the first through the same keyhole approach.

Am I too old for TAVI?

Age alone almost never rules TAVI out; indeed, the procedure was designed for patients for whom surgery felt too great an undertaking. Nonagenarians undergo TAVI successfully every week in London. What matters is overall fitness, anatomy and what you want from treatment, which is exactly what the assessment establishes.

Will I be awake during the procedure?

Many TAVIs are now performed under sedation with local anaesthetic at the groin, so you are comfortable and drowsy rather than under a full general anaesthetic. Your heart team will recommend the most appropriate approach for you.

How soon will I feel the benefit?

Often remarkably quickly. The new valve works from the moment it opens, and many patients notice easier breathing within days, with strength and stamina continuing to build over the following weeks as the heart recovers.

What medication will I need afterwards?

Most patients take antiplatelet therapy, commonly aspirin, long term, with any additional blood thinners guided by other conditions such as atrial fibrillation. We will rationalise your medication after the procedure and keep your valve under regular echocardiographic surveillance.

What if I also have coronary artery disease?

This is common and is assessed as part of the TAVI work-up. Significant narrowings can be treated with angioplasty and stenting, before, during or after the valve procedure, and the heart team will sequence treatment for the best overall result.

Why choose Dr Assomull?

Dr Assomull provides expert valve assessment at 68 Harley Street, imaging-led, unhurried and honest, presents your case within London's specialist heart-team programmes, and remains your cardiologist after the procedure: overseeing recovery, medication and lifelong valve surveillance so your new valve serves you well for years.

If aortic stenosis has been mentioned, or exertional breathlessness is creeping in, book a consultation, usually available within one working day.