What Is TAVI? Transcatheter Aortic Valve Replacement Explained

TAVI is all about planning. Doing TAVI is not a great job — it doesn't need very high level skills, but the whole energy should be dedicated to planning before you embark on the procedure. That planning is a thorough CT scan, which could be conducted locally and sent to us, and then we can plan around that CT finding as to which valve is required and what we're going to face in terms of coronary occlusion, groin complications or stroke. Mortality in TAVI can be very high if you are not careful about the groin — you should know pretty well how to manage it. The whole thing is around planning, planning, planning, planning.

SAVR is a very well-established technique for the last 50-plus years, and given a choice in terms of safety it should be the default choice in my opinion. Although I do TAVI quite a lot, I would still prefer a technique that is well proven and very well established — especially if the valve happens to be a bicuspid valve, a small annulus, or the patient is not very elderly. If my surgeon says the surgical risk is very high, then I chip in and accept those patients for TAVI. Though in recent trials TAVI has been established as non-inferior even for intermediate to low-risk populations, the decision should still be individualised on the merit of the patient.

As far as cardiology goes, the basic screening tools would be a thorough echocardiography and ECG, blood tests like lipid profiles, CRP values, and HbA1c for underlying diabetes mellitus, and sometimes even a stress test to dig out coronary artery disease. These are classical tests conducted in most people who have passed the age of 40 or 45, and especially the elderly — a thorough echocardiography usually digs out the necessary information, and then we start acting on the preventive aspect.

They should be in touch with us and send their CVs. They should be ready to face a physical interview, maybe online or coming here, and then we appraise them that they're fit to be inducted into our program. There are some local country regulatory bodies that clear their CVs — that part is also done by BLK. There are minimal fees involved, and they have to make their local arrangements for stay, food and clothing — and people have really been benefited by being with us in our lab, and we give them hands-on experience at some stage.

It's difficult to comment on this. It could be a vascular lump or some kind of arteriovenous fistula in the palm, but one has to do a thorough CT scan, a contrast CT, or maybe a DSA, and then only one can find out as to what is the reason — and can also fix it by minimally invasive technique, putting in a covered stent or coils accordingly. But one has to first prove what we're dealing with; I can't say on this bare information.

TAVI is a way of replacing a diseased aortic valve using a tube and wire threaded through the body, without opening the chest, in much the same way an angioplasty is performed.

A TAVI valve is a tissue valve, similar to a surgical valve given to elderly patients, and is expected to last at least 10 to 15 years.

The procedure is swift, typically taking about 20 to 30 minutes, and in most cases is performed without general sedation, with the patient able to talk throughout.

Conventional surgical aortic valve replacement involves opening the chest and suturing in a new valve, while TAVI achieves the same outcome for many patients through a small puncture, most often in the groin.