TAVI (Transcatheter aortic valve implantation)

What is a TAVI?

TAVI is a medical abbreviation (name) for a transcatheter aortic valve implantation procedure. It improves the blood flow in your heart by replacing an aortic valve that doesn’t open fully.

TAVI can also be called Transcatheter aortic valve replacement (TAVR). There is no difference between TAVI and TAVR – they are just different names for the same procedure. TAVI is more commonly used in the UK, TAVR in the USA.

TAVI is a common, mostly painless procedure. A narrow flexible tube (called a catheter) is put into a blood vessel in your upper leg or chest and is passed towards your aortic valve in your heart. The tube is used to fix a replacement valve over the top of your old one.

Why would you need a TAVI?

If you have a condition called aortic stenosis, your aortic valve doesn’t open fully.

Your heart valves play an important role in keeping blood flowing through your heart. The aortic valve opens to let blood flow from your heart to your aorta. The aorta is the big vessel supplying your body with oxygen-rich blood.

If you have severe aortic stenosis, you may need to replace your aortic valve.

TAVI was originally used as an alternative to heart valve surgery for people who weren’t well enough to have open heart surgery to replace their aortic valves. But TAVI is now being used for people at lower risk of complications from heart surgery because research is showing it’s at least as effective as heart valve surgery after one year. TAVI is also showing signs of working over a longer period, but more research is needed before it becomes the first choice for patients with severe aortic stenosis.

We encourage you to discuss with your doctor whether TAVI or heart valve surgery is right for you. They should talk through your options and listen carefully to your views and concerns before you agree to having the procedure. Your family can be involved too, if you wish. It can feel hard to ask questions about difficult topics such as risks and life expectancy, but most people feel better once they do.

To help decide whether TAVI is right for you, you may have one or more of the following tests:

• Blood tests
• Echocardiogram
• ECG
• CT scans
• Coronary angiogram
• Trans-oesophageal echocardiogram (TOE)
• Chest X-ray
• Breathing tests

Many people feel scared to have tests or worry they will hurt but the tests are normally quick and painless. Your doctor or nurse will talk you through what each test involves and can answer any questions.

How successful are TAVI procedures? 

In most cases, people find their symptoms get better after a TAVI procedure and they are able to do more in their daily lives. A smaller number of people may have complications after a TAVI procedure. The risk varies depending on your overall health and your individual heart condition.

You can improve your chances of long-term success and reduce the risks of TAVI by making healthy lifestyle changes, including: 

• Eating more healthily
• Getting more physically active  
• Giving up smoking 
• Cutting down on alcohol  
• Taking prescribed medicine 
• Keeping teeth and gums clean and healthy (this is the most common route that bacteria enter the bloodstream)
• Having a dental check-up, to make sure your teeth and gums are healthy, to reduce the risk of endocarditis

How long does a TAVI heart valve last?

More research is needed before we can say for certain how long TAVI valves typically last. For most people, six years after a TAVI procedure, their TAVI valve will still be in good condition. This will likely improve as techniques and technology evolve.

What are the benefits of TAVI? 

The benefits and risks of TAVI are different for everyone and depend on the seriousness of your aortic stenosis, your age, and your overall health. The benefits of TAVI can include: 

• relief from or less pain (if you had angina) 
• relief from or less breathlessness 
• relief from or less tiredness  
• relief from or less dizziness and fainting
• more energy – with better blood flow through your heart, everyday tasks and physical activities become easier and more enjoyable  
• better mood and mental health  
• reduced risk of heart failure and death

In comparison with open heart aortic valve surgery, benefits of TAVI include:

• less risk of death and strokes
• a shorter hospital stay
• a quicker overall recovery

Have a chat with your doctor about the benefits and possible risks of having a TAVI and any concerns you may have. 

What are the risks of TAVI? 

All types of medical procedures come with risk. With TAVI, some of the more common complications can include:  

• an irregular heart rhythm, which may mean you’ll need a pacemaker fitted
• bleeding, bruising, damage, or an infection where the catheter tube is put into the body (in upper leg or chest)
• blood clots and strokes – although following TAVI you’ll be given anti-clotting drugs to reduce your risk 

Rarer risks of TAVI include: 

• a heart attack during the procedure
• kidney problems for the first few days
• endocarditis – where the inner lining of heart chambers and valves becomes infected
• death (although the risk is far lower than the risks of leaving severe aortic stenosis untreated)

A small number of people will need open heart surgery to correct complications that happen during the TAVI procedure.

In comparison with open heart aortic valve surgery, TAVI has a greater risk of people needing a pacemaker permanently fitted afterwards.

If you’re worried or have more questions, we encourage you to ask your doctor. They’ll be able to answer any questions specific to you and your procedure.

What happens during a TAVI?

• You’ll be asked not to eat or drink for four to six hours before the TAVI procedure
• You'll change into your gown and will be asked to remove any jewellery that might get in the way
• You will usually be awake and lying on your back for the TAVI. You’ll be given a medicine called a sedative to help you relax
• You’ll be given a local anaesthetic injection so you won’t feel any pain in your upper leg or under your collar bone. A thin tube (the catheter) is then passed into your artery through the numbed area
• The tube is then passed into the opening in your aortic valve and a new valve, made of metal and animal tissue, is positioned inside the old valve
• The valve either expands by itself or a balloon at the end of the catheter tube may be blown up to make room for the new valve
• During your procedure, you’ll be closely watched by your healthcare team. You will be attached to a heart monitor that records your heart rate and rhythm and you’ll have a clip measuring your oxygen levels on your finger. You’ll also have your blood pressure checked regularly
• Many people experience a feeling of pressure during the TAVI. If you feel unwell, or have chest pain at any time, tell the team
• After the procedure, the catheter tube is taken out and there may be a small amount of bleeding when it is taken out
• You’ll then come back to the recovery room and a few hours later be transferred to the ward
• You’ll usually leave the hospital after a day or two, but discharge times can be different for everyone

Your TAVI procedure will take place in a cath lab – a sterile room in the hospital that looks like an operation room.

Watch our video to find out what happens during a TAVI procedure:

How to prepare before a TAVI procedure

Preparing for a TAVI procedure can help reduce any stress and anxiety you may feel. It can help reduce your risk during the procedure and improve your recovery afterwards. Preparation may include:

• arranging for someone to look after you during recovery
• organising transport to and from the hospital
• organising time off from work, or other responsibilities
• continuing to take medication
• eating healthy foods (use our recipe finder for tasty and heart-healthy ideas)
• managing your weight
• stopping smoking
• looking after your mental health
• staying active
• keeping teeth and gums clean and healthy
• getting a check-up with your dentist – to reduce your risk of endocarditis

Read our five top tips on getting ready before a procedure so you’re as prepared as possible.

Recovery after a TAVI procedure

Most people go home one to two days after a TAVI procedure but you may have to stay in hospital a little longer.

After your TAVI procedure, you might have bruising or tenderness in the area where you had the catheter tube put in. This should wear off in a few days. You can ask the nurses looking after you to give you painkillers if you need them. When you get home, check the area where the catheter tube was put in. You should contact your doctor if:

• you get any redness or swelling
• or the pain gets worse
• or the bruising gets worse
• or you develop a temperature

Before you leave hospital, someone will have a chat about what you can and can’t do. Usually, you’ll be advised not to lift, pull, or push anything heavy (like a vacuum) for:

• one week, if you had your TAVI procedure through your upper leg
• six weeks, if you had your TAVI procedure through your chest

When you leave hospital, you’ll be given medication to help you avoid blood clots. You’ll be told how long you need to take it for. Any changes to any other medication you are on will also be discussed. If you have any concerns about your medication after you leave hospital, speak to your GP or pharmacist.

Once you leave hospital, you will probably have a TAVI nurse that can offer support and/or be invited to cardiac rehab.

It takes people different periods of time to recover after a TAVI procedure. Most people take about six to ten weeks to feel fully recovered.

A few weeks after the procedure, you will probably have a follow-up appointment with a cardiologist at the TAVI centre. After this your local cardiologist or GP normally takes over your care.

Recovering from a TAVI can be emotionally difficult as well as physically. People often tell us they've felt low, frustrated and detached from others after big health events like this. It's very normal and the feelings usually improve as you recover.

Talk to your family, friends and GP about how you're feeling as this will help.

• Find out about other ways to get emotional support

When can you exercise after a TAVI procedure?

After a TAVI procedure, it’s best to avoid doing any demanding activities, such as lifting anything heavier than two litres of milk, vacuuming, or gardening, for:

• one week, if you had your TAVI procedure through your upper leg
• six weeks, if you had your TAVI procedure through your chest

Walking is one of the best forms of exercise after a TAVI procedure.

You may find what you are able to do varies from day to day, but as you recover you should be able to do more than you could before your TAVI procedure. Stop any activity if you feel any of the following symptoms:

• breathlessness
• unusual tiredness
• chest pain
• dizziness

It's important to discuss with your doctor before beginning any physical activity for the first time or increasing the level of the activity. They can answer any questions you may have about exercising after TAVI and provide you with specific information to help you safely get active.

• Get tips on rest, recovery and pacing yourself

How long after a TAVI procedure can you drive?

You shouldn’t drive for at least four weeks after having a TAVI procedure.

If you drive a heavy vehicle for a living, such as a lorry or a bus, you must tell the Driver and Vehicle Licensing Agency (DVLA) that you've had a TAVI procedure. They'll arrange further testing before you can return to work.

• Find out if you’ll need to tell the DVLA about your condition

How soon can you fly after having a TAVI procedure?

It’s not generally recommended to take a long-haul flight soon after having a TAVI procedure but if you are generally well, and have chatted through your circumstances with your doctor, you may be fit to fly:

• One week after a TAVI procedure through your upper leg
• Two weeks after a TAVI procedure through your chest

TAVI valves are not detected by airport security scanners.

You must let your holiday travel insurance company know about the TAVI procedure.

• Find out about travel insurance and heart conditions

When can I return to work after a TAVI procedure?

If you’ve had a TAVI procedure, you may be able to return to work after two weeks, depending on the type of work you do.

You should chat about your own situation with your doctor or nurse.

• Find out more about taking time off work if you’ve got a heart condition

Antibiotic cover for dental surgery 

If you need to have dental surgery after you’ve had a TAVI, talk to your dentist about whether antibiotics will be needed to help prevent infection. Although antibiotics aren’t usually prescribed after dental procedures, gum disease and mouth infections increase the chance of infections around your heart valve.

Your dentist will look at your case and sometimes speak to other health professionals before deciding whether you’ll need antibiotics.

• Find out more about dental treatment and antibiotics

How can I get emotional support?

As the day of your TAVI procedure gets closer, you may feel anxious, afraid, angry, worried about the future, or glad that you’re about to have treatment.

It’s natural to have these feelings and you may continue to have them after the procedure. It’s important to talk about your feelings with your partner, a friend, relative or healthcare professional.

You can also get support by:

• Chatting with online, emailing, or calling our expert cardiac nurses
• Chatting with your GP about getting talking therapy, or, if you’re in England, you can refer yourself for therapy through Improving Access to Psychological Therapies (IAPT)
• Joining a support group or online community
• Signing up to our Heart Matters magazine and email newsletter, packed with health and recovery tips
• Joining a Heart Support Group near you