Transcatheter Aortic Valve Implantation (TAVI)

TAVI stands for transcatheter aortic valve implantation — a keyhole technique to replace a narrowed aortic valve without open-heart surgery. It is also known as TAVR (transcatheter aortic valve replacement). The new valve is delivered through a thin tube, usually via an artery in the groin, and implanted inside your own valve while the heart continues beating. It is done with the patient awake (conscious sedation and local anaesthetic).

TAVI treats severe aortic stenosis — a narrowing of the aortic valve, the heart's main outflow valve, which forces the heart to work progressively harder. It is the most common valve disease in the UK and typically causes breathlessness, chest tightness, dizziness or blackouts. Once symptoms develop, the outlook without valve replacement is poor, and it is important to understand that no medication alters the progression or prognosis of aortic stenosis — the only effective treatment is to replace the valve.

TAVI requires careful assessment and planning, both to confirm it is the right option for you and to make the procedure as safe as possible. The pathway begins with a consultation to review your symptoms and the investigations you have had so far. Severe aortic stenosis is usually confirmed with a transthoracic echocardiogram; occasionally further tests are needed. The procedure itself is planned from a dedicated TAVI CT scan, which is normally arranged soon after your first consultation and allows the valve size, delivery route and each step of the procedure to be mapped precisely. A coronary assessment is also carried out where needed — you can read more on the coronary angiography page.

Every patient is discussed at a specialist multidisciplinary meeting (the Heart Team), bringing together cardiologists and cardiac surgeons. The purpose is simple: to recommend the safest and most effective treatment for you, and to plan it in detail.

Broadly, there are three possible recommendations. For many patients, TAVI is the preferred option. For some — often younger patients or those with particular anatomy — conventional surgical valve replacement may be the better choice. Rarely, the risks of any intervention are prohibitive, and supportive drug treatment is recommended instead, recognising that medication controls symptoms only and does not change the course of the disease. Whatever the recommendation, Dr Demir will explain the reasoning openly and answer your questions.

Replacing a severely narrowed aortic valve — by TAVI or surgery — relieves symptoms, improves quality of life and extends life expectancy. Large clinical trials have shown TAVI achieves outcomes comparable to surgical valve replacement in most patient groups, with a faster recovery. Some patients notice their breathing improve almost immediately; for others the benefit builds over the following weeks as activity returns.

No procedure is without risk. You will be given an initial estimate of your risks at consultation, and once the TAVI CT is completed, a detailed assessment specific to your anatomy — covering risks such as vascular complications, the need for a pacemaker, stroke and, rarely, more serious events. This is provided face to face and in writing, with time for you and your family to ask questions before you decide.

The procedure is usually performed under sedation with local anaesthetic, occasionally under general anaesthetic — this is agreed with you and the anaesthetist in advance. The valve, made of cow or pig heart tissue mounted on a metal stent frame, is delivered through the femoral artery in the groin and expanded within your own aortic valve, taking over its function immediately. The procedure takes around an hour. Most patients are up and walking the same day or the following morning, and are home within 1–3 nights depending on their circumstances.

You will usually be advised to avoid heavy lifting and strenuous activity for a short period while the groin heals. A follow-up echocardiogram confirms the new valve is working well, and most patients take antiplatelet medication (such as aspirin) afterwards, tailored to their circumstances. Modern TAVI valves have excellent durability data, with valves functioning well beyond ten years in long-term studies.

Dr Demir is a Consultant Interventional and Structural Cardiologist whose subspecialty focus is aortic stenosis and TAVI. He trained at leading London hospitals including St Thomas’ and Hammersmith, and completed completed advanced structural intervention training at San Raffaele Hospital, Milan, one of Europe's highest-volume valve centres, holds a PhD from King's College London, and leads active research in aortic stenosis. He performs TAVI procedures regularly (usually several weekly) at the Essex Cardiothoracic Centre. In addition, he offers private TAVI at leading London Hospitals including the Cromwell and Wellington Hospitals.

If you have aortic stenosis, a heart murmur, or symptoms such as breathlessness, chest tightness or blackouts, contact Ms Amelia Garner (PA) on 020 3198 9826 or drozandemir.sec@outlook.com to arrange a specialist assessment.