Diagnosis and treatment: aortic stenosis

The aortic valve is in the left side of the heart. It opens and closes when blood is pumped out of the left ventricle - the main pumping chamber of the heart - into the aorta - the large artery that runs the length of the body, providing the body's other organs with blood.

Aortic stenosis is a condition where the aortic valve becomes narrowed and stiff due to a build up of calcium. Over time the valve fails to open and close properly making it harder for the heart to pump blood out to the rest of the body. As the left ventricle has to work harder it gradually gets bigger and the muscle works less efficiently, leading to signs of heart failure. Symptoms of aortic stenosis may include breathlessness, chest discomfort, dizziness, collapse and swollen ankles.

What is transcatheter aortic valve implantation (TAVI)

TAVI is a way of replacing the existing valve with a new tissue valve, thereby improving how the heart works without the need for open heart surgery. You may have been referred for the procedure as the alternative (open heart surgery) has been deemed unsuitable by your cardiologist or cardiac surgeon. 

TAVI is currently only offered to patients who have been declined open heart surgery. A conventional aortic valve replacement remains the gold standard of treatment for aortic stenosis.

TAVI involves placing an artificial valve into your heart. This is done by introducing a thin tube, also known as a catheter, through a small cut either at your groin - called a transfemoral TAVI - or via the left hand-side of your chest - known as a transapical TAVI. The valve which sits within a small metal cage, also known as a stent, is crimped onto the end of the catheter. When the catheter is correctly positioned within the heart, the heart is paced very quickly using a temporary pacing system. A small balloon is inflated and the valve opens up as the balloon expands. The balloon is then deflated, the pacing is stopped and the valve is held in position by the surrounding stent. The catheter is then removed and the small incision is stitched closed.

Video showing a transfemoral TAVI

Video showing a transapical TAVI