TAVI (Transcatheter Aortic Valve Implantation) is a procedure where a new aortic valve is placed via catheter without open-heart surgery in patients with severe aortic stenosis. This revolutionary treatment offers a life-saving option, especially for elderly patients with high surgical risk. TAVI is successfully performed at experienced centers in Turkey.
What is TAVI?#
TAVI stands for “Transcatheter Aortic Valve Implantation.” In this procedure, a bioprosthetic valve in a folded state is delivered to the heart via catheter without removing the damaged aortic valve, where it opens and begins to function.
TAVI was developed as an alternative to traditional open-heart surgery. First performed in France in 2002, it has now been successfully applied to hundreds of thousands of patients worldwide.
What is Aortic Stenosis?#
The aortic valve is located between the left ventricle and the aorta and ensures one-way blood flow. Aortic stenosis is the narrowing of this valve, making it difficult for blood to pass into the aorta.
Causes of Aortic Stenosis#
- Degenerative calcification: The most common cause, calcium accumulation in the valve with aging
- Bicuspid aortic valve: Congenital two-leaflet valve (normally three leaflets)
- Rheumatic heart disease: Valve damage after rheumatic fever
Symptoms of Aortic Stenosis#
The classic three symptoms of severe aortic stenosis:
- Chest pain (angina): Pain that occurs with exertion and resolves with rest
- Shortness of breath: Initially with exertion, later at rest
- Syncope (fainting): Sudden loss of consciousness, especially during exertion
If these symptoms appear and are not treated, the risk of death within 2-5 years is very high.
Who is TAVI Suitable For?#
TAVI is performed in patients with severe symptomatic aortic stenosis. Patient selection is made by the “Heart Team.”
TAVI Indications#
- High surgical risk patients: STS score ≥8% or EuroSCORE II ≥4%
- Intermediate surgical risk patients: With individual assessment
- Low surgical risk patients: In selected cases (over 75 years, suitable anatomy)
- Patients unsuitable for surgery: Porcelain aorta, previous chest radiotherapy
Contraindications for TAVI#
- Active endocarditis
- Acute myocardial infarction
- Severe left ventricular dysfunction (EF <20%)
- Unsuitable vascular anatomy
- Life expectancy <1 year
How is TAVI Performed?#
TAVI is performed in a hybrid operating room or catheterization laboratory.
Pre-Procedure Preparation#
- Comprehensive cardiac evaluation (echocardiography, coronary angiography)
- Cardiac CT angiography (evaluation of aorta and peripheral vessels)
- Anesthesia evaluation
- Blood tests and general health check
Procedure Steps#
1. Anesthesia
- General anesthesia or sedation + local anesthesia
2. Vascular Access
- Transfemoral (groin artery) - most commonly used route
- Transapical (heart apex) - if femoral route is not suitable
- Subclavian or transaortic - alternative routes
3. Valve Placement
- Guidewire is passed through the aortic valve
- Balloon valvuloplasty to expand the valve (in some cases)
- Folded valve is positioned
- Valve is deployed and placed
4. Control and Completion
- Valve function is evaluated
- Paravalvular leak check
- Vascular access is closed
Procedure Duration#
A typical TAVI procedure takes 1-2 hours. Patients usually stay in the hospital for 1-3 days.
TAVI Valve Types#
Main TAVI valves currently in use:
| Valve Type | Feature |
|---|---|
| Edwards SAPIEN 3 | Balloon-expandable, bovine pericardium |
| Medtronic Evolut | Self-expanding, porcine pericardium |
| Boston Scientific ACURATE | Self-expanding |
| Abbott Portico | Self-expanding, repositionable |
Valve selection is based on the patient’s anatomy and operator experience.
Advantages of TAVI#
Advantages of TAVI compared to traditional surgical valve replacement:
- Minimally invasive: No sternotomy required
- No heart-lung machine needed: Heart is not stopped
- Short hospital stay: 1-3 days (7-10 days for surgery)
- Rapid recovery: Early return to daily activities
- Low complication rate: In high-risk patients
- Local anesthesia option: For patients with high general anesthesia risk
TAVI Risks and Complications#
Like any medical procedure, TAVI has risks:
Common Complications:
- Vascular complications (5-10%)
- Permanent pacemaker requirement (5-15%)
- Paravalvular leak (mild-moderate)
- Transient rhythm disturbances
Rare Complications:
- Stroke (1-3%)
- Coronary artery occlusion (<1%)
- Valve embolization (<1%)
- Aortic rupture (<1%)
- Death (1-3%)
These rates are continuously decreasing with modern techniques and experienced teams.
Life After TAVI#
Patients generally recover quickly after TAVI:
First Week:
- Light activities
- Wound care
- Medication adjustment
First Month:
- Gradual increase in activity
- Control echocardiography
- Start of cardiac rehabilitation
Long Term:
- Annual echocardiography follow-up
- Antiplatelet therapy (usually aspirin)
- Endocarditis prophylaxis (before dental procedures)
TAVI Outcomes#
Clinical studies have proven the effectiveness of TAVI:
- 1-year survival: 85-90%
- 5-year survival: 50-60% (in high-risk patients)
- Symptom improvement: In more than 90% of patients
- Quality of life: Significant improvement
Frequently Asked Questions#
Is TAVI surgery?
How long does a TAVI valve last?
Do I need to take blood thinners after TAVI?
Is the TAVI procedure painful?
When can I return to normal life after TAVI?
Appointment and Contact#
If you would like to schedule an appointment for TAVI evaluation or aortic valve disease treatment:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Valve Treatments#
Other structural heart treatments related to TAVI:
- Aortic Valve Disease - About aortic valve diseases
- Balloon Valvuloplasty - Balloon valve dilation
- Echocardiography - Valve assessment
- Heart Failure - Heart failure treatment
- CABG - Coronary bypass surgery