TAVI: heart surgery for aortic valve replacement

Written by: Mr Inderpaul Birdi
Published: | Updated: 21/11/2019
Edited by: Laura Burgess

TAVI stands for Transcatheter Aortic Valve Implantation and may also be known as TAVR, where the letter ‘R’ stands for replacement. TAVI is used to treat a condition called severe aortic valve stenosis where the aortic valve has become calcified and tight.

If you are in need of heart valve surgery and are not well enough for the traditional procedure used in valve replacement surgery, you may be given a TAVI operation instead.

We’ve asked one of our highly-experienced cardiothoracic surgeons Mr Inderpaul Birdi to share how the procedure is performed and how it differs from open-heart surgery.
 

How are TAVI procedures performed?

Most TAVI procedures are performed by passing a guided wire through an artery in the groin over which is inserted the new collapsed aortic valve replacement. Once the TAVI valve is placed in the correct position inside the calcified valve, the TAVI valve is opened into place. TAVI is most useful in patients in whom surgical aortic valve replacement is too risky.
 

How is it different from standard procedures?

Standard aortic valve replacement is performed by using open-heart surgery through the breastbone. Some surgeons, myself included, can perform heart surgery without opening the breastbone and instead by placing a small incision between the ribs on the right side of the chest, which is the TAVI procedure and does not require any incisions.

The compromise of TAVI, however, includes:

  • There is a 25% risk of pacemaker (compared to 3-4% with traditional or keyhole heart surgery).
  • There is a 25% risk of leaks around the edges of the new TAVI valve with increased risk of shortened life or heart failure (compared to 2-3% with traditional or keyhole heart surgery).
  • The unknown long-term durability of the new valve.
     

Why would you have this procedure?

Patients who are not suitable for traditional or keyhole heart surgery because of coexisting illnesses that make surgery too risky are to have TAVI. This is assessed by a specialist heart team like the one at The Keyhole Heart Clinic.
 

How long are TAVI valves supposed to last?

This is currently unknown but early results indicate that TAVI valves are not as durable as traditional surgical tissue valves, mechanical valves, or carbon valves.
 

What is the success rate of this?

This depends upon the preoperative risk of the patient but early data has not demonstrated any mortality or stroke reduction in TAVI versus traditional or keyhole surgery.

 

Book for a consultation with Mr Birdi today!

By Mr Inderpaul Birdi
Cardiothoracic surgery

Mr Inderpaul Birdi is an experienced traditional and keyhole (minimally invasive) heart surgeon. He works privately at The Keyhole Heart Clinic where he carries out keyhole mitral, aortic and tricuspid valve surgery, coronary bypass surgery, TAVI, atrial fibrillation ablation and general cardiac surgery. He is also one of only a handful of surgeons in the world who can perform keyhole coronary bypass surgery, and keyhole aortic valve repair. He founded The Keyhole Heart Clinic to provide patients with information and clinical access to specialised minimally invasive cardiac therapies within the most prestigious hospitals in the UK. 

Mr Birdi trained in medicine in the UK and trained in cardiothoracic surgery at the world acclaimed Royal Papworth Hospital. He undertook research at The Bristol Heart Institute and contributed numerous publications to leading international journals. 

Alongside his private practice, the lead consultant for minimally invasive cardiac surgery at The Essex Cardiothoracic Centre which provides both NHS and private facilities and delivers one of the largest keyhole valve programs in the UK. He also works at The Harley Street Clinic and The Wellington Hospital, London.

Mr Birdi is now leading a team to develop a world-class robotic cardiac surgery program in the UK. He is involved in several multi-centre randomised trials as a primary investigator and involved with many world-class clinicians in a wide array of clinical specialities, tasked to develop international VIP clinical services in the United Kingdom. He is a member of the International Society of Minimally Invasive Cardiac Surgery and the Royal Society of Medicine.

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