Transcatheter aortic valve implantation (TAVI) service

Before you are admitted to hospital

A clinical nurse specialist from the TAVI team will conduct a pre-assessment with you which normally takes place by telephone around two weeks before your admission date. However, if necessary, you may need to attend the hospital for blood tests and a face-to-face pre-assessment. The nurse will review your medical history, current medications and briefly explain the procedure and answer any questions or concerns you may have.

If you are admitted in another hospital, the medical team will organise everything for your transfer to St Bartholomew's. We will also contact your family or next of kin, should you wish for us to do so. 

Patients usually come to hospital the day before their TAVI procedure. You can eat and drink as normal and continue to take your medications. Some of your medications may be stopped before your TAVI and this will be discussed with you during the pre-assessment. 

Travelling to hospital

You can arrange transport to hospital by calling 0207 767 334. You must arrange your transport at least three days prior to your admission or appointment date. Where possible, we recommend that a relative or friend drives you home or accompanies you on the journey home.

What to bring to hospital? 

A list of all the medications you take, including those bought without prescriptions

• Eyeglasses, hearing aids or dentures
• Personal care items such as a brush or comb, toothbrush
• Loose-fitting and comfortable clothing
• Items that may help you relax  (e.g., book, magazine)

Dental care

It is important to maintain a good oral health especially if you have a heart valve disease. Poor dental health increases the risk of a bacterial infection in the blood stream, which can affect the heart valves and may lead to a heart infection called ‘Endocarditis’. Therefore, it is essential that you have regular dental checks. Please register to a local dental practice if you do not see a dentist regularly.

On the day of the procedure, you will be brought to the cath lab. Our team will check your details, and you will be transferred onto the operating table. You will be attached to a heart monitor to continuously check your heart rate and rhythm, blood pressure and oxygen levels throughout the entire procedure. Your groin will be cleaned and then you will be injected with local anaesthesia to numb the area.

Under local anaesthetic, a small tube called a sheath will be inserted in the artery at the top of one of your legs or arm for taking pictures during the procedure. A slightly bigger sheath will be inserted into the artery at the top of your other leg, which the new valve will go through. Sometimes, a temporary pacemaker will be put into your heart through a vein in your neck or leg in case the doctor needs to speed up your heart during the procedure

Catheters (small tubes) are passed through the bigger sheath to pass a long ‘guide wire’ across the narrowed aortic valve. The new aortic valve is then advanced over this wire (like a train on rail tracks) until it is in place inside your narrowed valve and then expanded to push the narrowed valve open, creating a new valve within it. A small balloon (‘balloon catheter’) may be used to widen your narrowed aortic valve before the new aortic valve is placed. It may also be used to widen the new aortic valve after it has been implanted.

During implantation of the valve or ballooning, the heart is made to speed up at higher rates and you may feel palpitations or dizziness during this which should resolve within a few seconds. 

Once the valve has been successfully implanted, the tubes from your legs will then be removed and closed with dissolvable sutures and a specialised collagen plug to aid in the blood vessel’s healing and closure.

Local anaesthetic

The majority of procedures can be carried out with local anaesthetic, often with little or no sedation. This means you will be awake during the procedure. You may feel some discomfort when the tubes are inserted and during placement of the valve, but this is normally short-lived.

In some cases, the blood vessel in the leg is not big enough or may be diseased and therefore the valve has to be inserted via a different route. If we require these alternative routes, as discussed above, (subclavian, transapical, transcaval) a general anaesthetic may be used.

Recovery

After the procedure you will be taken to a recovery ward for close observation. Once you are well enough, you will be moved back to the cardiology ward where you were first admitted. As you recover, you will be closely monitored. You will have to stay in bed for about 4-6 hours after the procedure to allow the blood vessels to heal and close. After this, you will be gradually sat up and encouraged to walk around the ward to see how you get on.

If you experience any pain, this will be treated with pain-relieving drugs.

The length of stay in hospital following the procedure is different for everyone. As a general guide, for uncomplicated procedures and majority of the patients are usually ready to go home the day after their procedure after having some blood test and a repeat ultrasound scan of their heart. 

Leaving hospital

Normally, you can expect to be in hospital for approximately two nights. Before you go home, the TAVI team will check your wound and overall well-being. You will need to be accompanied by a relative or friend on your journey home. If you need to use our patient transport service, please advise us at the earliest opportunity of your need as this can be arranged by the ward nurses upon your discharge. We recommend that there is someone with you in the first 24 hours after the discharge. 

Resuming exercise and other activity

Everyone is different so recovery times do vary. As soon as you are walking comfortably around your home, you can carry out light housework and gradually build up your strength. For the first week, please refrain from any strenuous activity such as: Carrying heavy shopping bags, gardening or strenuous exercises such as jogging, swimming, dancing and cycling. Walking is the best form of exercise you can take following a TAVI. You may find that the amount you can manage varies from day to day. 

On your discharge from hospital, it is fine to return to your normal daily activities with the following precautions:

• Do not lift anything heavier than 5 pounds (2.3 kilograms) for example: laundry baskets, grocery bags, telephone, luggage, pets, children or infants. Do not push or pull heavy objects such as furniture or appliances for one week post-procedure. 
• Housework or garden work: Do not do strenuous house work such as sweeping, mopping, scrubbing, hovering or gardening for the first one to two weeks.
• Stairs are safe to use, but not as exercise. Limit use of stairs to once or twice a day for the first one to two weeks. Take your time, go slow, and pause to rest if you feel tired. Hold onto the handrail. 
• You are not allowed to drive for four weeks after your procedure. You do not need to inform the DVLA about your procedure unless you hold a commercial license. If this is the case, you will need to call them for further advice.
• You can take a shower as soon as you get home, however, please avoid baths for one week after the procedure or until your groin incision is healed. Avoid extreme temperatures in the bath or shower. Lukewarm water is best and use mild unscented soap.
• You can fly a week after your procedure, but you may wish to wait until after your first follow up appointment. You may want to discuss with the TAVI team before you make any plans to travel abroad. You must also inform your holiday insurance company about the TAVI procedure that you had. 
• Avoid sexual activity until your follow-up appointment with the TAVI team. Upon returning to sexual activity, listen to your body, take your time, and stop and rest if you feel pain or pressure in your chest.
• Returning to work depends on your job and on your recovery. Discuss your return to work with your cardiologist or one of the members of the TAVI team upon your discharge.
• If you live alone, we suggest you arrange to have someone stay with you or help around to help you recover.

Each person will progress at different rates, and that is okay.  Walking is the best form of exercise you can take following a TAVI. You may find that the amount you can manage varies from day to day. Remember to listen to your body and know when it needs rest. You will be given a patient leaflet information that will include an exercise programme that you can follow after a few days of being home. If you would like to be referred to your local cardiac rehabilitation service, please contact your TAVI nurse specialist or the Barts Cardiac rehabilitation team on 02034656593 to take this forward. 

Wound care

It is normal for your groin to be tender for a few days after the TAVI. It is also common for a small bruise to develop but this should get better in a few weeks, otherwise, please do let us know. You can shower when you get home but please avoid rubbing the wound site, putting creams, powder or soap for one week. Please do not have a bath for one week. We use specialised stiches and plug to close the top of the groin wound. These help to keep the puncture site together and are dissolvable. It can take a few months for the stitches and plug to dissolve. 

You may be discharged home with dressings (plasters) on your groins. After 24hrs of being at home, you can take the dressings off and leave the wound open to the air. If you notice any signs of infection such as: pain, redness, swelling, oozing from the site, fever, loss of sensation in the foot/leg please contact your GP or our team for further advice. If your groin starts to bleed, apply firm pressure with your fingers above the bleeding point, and call for help by dialing 999. Do not drive yourself to the GP or A&E.

Follow-up appointments and medication

You will have a follow-up appointment around two to three weeks after your procedure. We may carry out an echocardiogram (an ultrasound of the heart) to check the function of the new valve and your heart. We usually will refer you back to your local cardiologist for further follow up appointments.

You will need to take a medication to prevent blood clots forming on the valve. We will inform your GP about the duration, which is usually for life. We may change other medications as necessary. The Pharmacist will ensure that you have enough supply of your regular medications before you are discharged from hospital.

Infection risk and dental care 

In order to minimise the serious risk of complications after heart surgery, such as infective endocarditis (‘heart muscle infection’), we strongly recommend that your teeth and gums are checked by your dentist regularly.  It is essential for you to inform your dentist about any previous valve surgery including TAVI whenever you are scheduled for any invasive dental procedures which can cause bleeding, such as having a tooth extracted, as you may need antibiotics prescribed prior to these. These procedures may increase the chances of bacteria entering your bloodstream causing an infection.

Travel and returning to work

You can fly one week after your procedure, but you may wish to wait until after your first follow up appointment. You may want to discuss with the TAVI team before you make any plans to travel abroad. You must also inform your holiday insurance company about the TAVI procedure that you had. 

Retuning to work will be different for each person and will depend on many factors, such as the overall state of your health and the type of work that you do. Please discuss this with your TAVI nurse specialists or doctor.

The structural heart service at Barts Heart Centre is one of the busiest referral centres in the UK.

In addition, to our TAVI service, we also perform mitral, tricuspid and pulmonary valve replacement procedures, including transcatheter edge-to-edge repair (TEER) along with other complex structural intervention cases.

All our TAVI inpatient referrals should be made via email along with our referal form.

TAVI inpatient referral form[docx] 289KB

Outpatient referrals can be sent to our individual consultants within the service or through our department mailbox.

Please submit the patient's most recent blood tests (FBC, renal profile, group and screen), echocardiogram images and if available, CT TAVI and angiogram images to Barts Heart Centre PACS via the Imaging Exchange Portal (IEP).

Please liaise with your imaging department to help facilitate this.

If these images are not available it may cause some delay in responding to your referal.

All members of the our team are involved in heart valve research and we are continuously developing new treatments.

You may be offered the opportunity to take part in studies for advanced treatments that are not routinely available. Your doctor or a research nurse will tell you about these studies and explain how you can take part. Please ask any member of the team if you are interested.

More information on the current research studies can be found on the British Heart Foundation website or contact the research nurses on 020 3765 8740.

TAVI Helpline (for patients and relatives)

Monday to Friday, 8am-4pm excluding Bank holidays

Call: 0203 765 8627

For clinic appointment queries call: 02037658638

Diagnostic appointments

Monday to Friday, 8am-5pm

1. Cardiac CT scans: 020 3465 6114/56117
2. Echocardiogram/TOE:  0207 377 7000 with extension 58154
3. Clinic1: 0207 377 7000 with extension 56457

Hospital transport

Please arrange your transport at least three days before your appointment by calling 0207 767 3344.

Information for patients

Trans-catheter Aortic Valve Implantation (TAVI) patient information leaflet[pdf] 527KB

Going home after your Trans-catheter Aortic Valve Implantation (TAVI) procedure[pdf] 273KB

Watch: What to expect as a TAVI patient at Barts Health NHS Trust