Transcatheter Aortic Valve Implantation (TAVI): Minimally Invasive Heart Surgery

• TAVI (Transcatheter Aortic Valve Implantation) is a minimally invasive procedure to replace a narrowed aortic valve. It may be a suitable option for older adults, patients with underlying medical conditions, and those at higher risk from open-heart surgery.
• TAVI generally involves less pain, a lower risk of complications, and a faster recovery than traditional open-heart valve replacement, which can help patients return to their daily activities sooner and improve their quality of life.
• TAVI valves are designed to be durable and can typically function well for 10–15 years or longer, depending on the individual patient and valve type.

Aortic stenosis is most commonly found in the elderly and it is caused by a degenerative change to the aortic valve, resulting in a narrowing of the valve or, in some cases, an inability of the valve to open and close properly. This causes the flow of blood from the heart to various parts of the body to be obstructed or reduced. As a result, the heart has to work harder than normal, which can cause heart failure.

This condition is more common than many people realize. It is estimated to affect about 1 in 8 adults over the age of 75. In most cases, it develops as calcium gradually builds up on the aortic valve over time. However, it can also occur in people born with a bicuspid aortic valve, which has two leaflets instead of the usual three, or as a result of rheumatic heart disease following rheumatic fever. Other risk factors, including diabetes, high blood pressure, high cholesterol, and smoking, may also contribute to or accelerate the development of aortic valve disease.

1. Unusual or persistent fatigue, particularly during physical activity
2. Dizziness, lightheadedness, or fainting, especially with exertion
3. Chest pain, pressure, or tightness, particularly during physical activity

These symptoms may indicate that the heart is struggling to pump blood effectively and that prompt medical evaluation is needed.

Once significant symptoms develop, aortic stenosis can progress and the risk of serious complications increases. In patients with severe symptomatic aortic stenosis who do not receive valve replacement, historical studies have shown a poor prognosis, with approximately 50% of patients dying within two years and around 80% within five years.

For this reason, if you experience these symptoms—especially during exercise—do not wait for them to improve on their own. Seek medical evaluation promptly to determine the severity of the valve disease and whether treatment is needed.

The replacement valve used in TAVI is a biological valve made from animal tissue, most commonly bovine (cow) or porcine (pig) tissue, mounted on a flexible expandable frame. The valve is compressed and loaded onto the tip of a catheter so it can be delivered through the blood vessels.

In most cases, the catheter is inserted through a small puncture in the femoral artery in the groin. This is the standard and most commonly used approach. If the femoral arteries are too narrow, heavily calcified, or otherwise unsuitable, an alternative access route may be considered, for example, an artery in the chest or near the collarbone, an advanced technique available at well-equipped heart centers like ours.

The catheter is carefully guided to the heart using real-time X-ray imaging, with other imaging techniques such as echocardiography used when needed to help ensure accurate positioning. The entire procedure is performed in a Hybrid Operating Room, which combines advanced imaging technology with the sterile environment and equipment of a surgical operating room. This allows the medical team to respond quickly if emergency surgery becomes necessary.

Once the catheter reaches the narrowed aortic valve, the new valve is positioned within the diseased valve and expanded. It pushes the old valve leaflets aside and immediately begins regulating blood flow from the heart. Unlike open-heart valve surgery, the heart does not need to be stopped during TAVI
 

TAVI may be an appropriate treatment option for patients with severe symptomatic aortic stenosis, depending on their overall health, age, life expectancy, anatomy, and surgical risk. The decision is best made by a multidisciplinary Heart Team after a comprehensive evaluation.

• Older adults, particularly those aged 80 years or older: TAVI is often favored in this age group because it is less invasive than open-heart surgery and may offer faster recovery. 
• Patients at high or increased risk from open-heart surgery: TAVI may be preferred when surgery is considered high risk because of frailty, previous heart surgery, or other medical conditions.
• Patients with significant coexisting health conditions: Conditions such as chronic lung disease, chronic kidney disease, liver disease, or poorly controlled diabetes may increase the risks associated with surgery. TAVI may be a suitable alternative in carefully selected patients, although the decision depends on the severity of these conditions and the patient’s overall health.
• Adults aged 65–80 years: Both TAVI and surgical valve replacement may be appropriate for many patients in this age group. The choice depends on factors such as valve and vascular anatomy, life expectancy, surgical risk, durability considerations, and the patient’s preferences.

When May TAVI Not Be Suitable?

• An active infection of the heart valves (infective endocarditis)
• A blood clot or other abnormal mass inside the heart
• Conditions that make the procedure or the required antithrombotic treatment unsafe, such as certain recent bleeding events or a high risk of serious bleeding. A recent stroke requires individualized assessment rather than automatically ruling out TAVI.
• Severe coronary artery disease requiring bypass surgery: If a patient needs coronary artery bypass grafting (CABG) at the same time as valve replacement, surgical valve replacement may be more appropriate than TAVI.

The choice between TAVI and surgical aortic valve replacement (SAVR) should be made by a multidisciplinary Heart Team, taking into account the patient’s age, overall health, surgical risk, heart and blood-vessel anatomy, coronary artery disease, life expectancy, and personal preferences.

TAVI is generally a safe and effective procedure, with a high procedural success rate. However, as with any heart procedure, there are potential risks. These may include bleeding, stroke, damage to blood vessels, kidney injury, and infection. The mortality risk is generally low, typically less than 5% in contemporary patients.

Another potential complication is a slow heart rate or heart block, requiring implantation of a permanent pacemaker. The need for a pacemaker is generally in the range of 5–10%.

Because TAVI is performed through a catheter rather than open-heart surgery, recovery is generally faster and most patients can get out of bed and resume light activities relatively quickly after the procedure. 

If the TAVI procedure is successful and the new valve is functioning well without significant leakage, most patients do not require any special maintenance for the valve itself. Modern transcatheter valves are designed to be durable, with clinical data supporting good valve function for at least 10 years and evidence of durability extending beyond this period. Your cardiologist will monitor the valve over time to identify any signs of valve deterioration.

Most patients will have regular follow-up with their cardiologist. Follow-up may include physical examinations, electrocardiograms (ECGs), and echocardiograms to assess the valve and heart function.

After TAVI, patients are usually monitored closely in the ICU for complications, particularly during the first 24 hours. Once their condition is stable, most patients can sit up and walk within a day. Hospital stay varies depending on the patient’s condition and the hospital’s protocol, but many patients can go home within 3-5 days after an uncomplicated procedure. 

For patients traveling from abroad, the timing of travel should be discussed with the treating cardiologist. After an uncomplicated TAVI, some patients may be able to take a short flight after approximately 1–2 weeks, while longer international travel may require more time (2-4 weeks or up to 6 weeks, depending on recovery and follow-up needs. Your cardiologist can advise when it is safe to travel and whether any additional precautions are needed.

• Take all prescribed medications exactly as directed, and never stop blood-thinning or antiplatelet medication without first speaking with your doctor.
• Maintain good oral hygiene and tell your dentist that you have a prosthetic heart valve. Antibiotic prophylaxis may be recommended for certain dental procedures.
• Keep the catheter insertion site clean and dry, and watch for increasing redness, swelling, bleeding, or discharge.
• Avoid heavy lifting and strenuous activity for the first 1–2 weeks, or as advised by your doctor.
• Gradually return to normal activities. Walking and other light activities are generally encouraged as your recovery progresses.

Follow-up schedule Patients typically return for an echocardiogram to check valve function at around 30 days after the procedure, then again at 6 months, and annually thereafter.

Our Heart Center offers a range of leading TAVI valve technologies, including valves from Edwards Lifesciences, Medtronic, and Abbott. This allows our Heart Team to select the valve that is most appropriate for each patient based on their individual anatomy, medical condition, and treatment needs.

Samitivej Sukhumvit Hospital also works with Edwards Lifesciences to provide the SAPIEN 3 Ultra transcatheter heart valve. This is an established, contemporary TAVI valve used internationally, giving patients access to advanced valve technology in Bangkok, delivered by an experienced multidisciplinary Heart Team.

Every TAVI procedure at Samitivej is led by a highly experienced cardiac interventionist who has personally performed more than 600 TAVI procedures, working closely with experienced cardiologists, cardiac surgeons, cardiac anesthesiologists, imaging specialists, and other members of the Heart Team. This multidisciplinary expertise supports careful patient selection, individualized treatment planning, and comprehensive care throughout the TAVI journey—from evaluation and procedure to recovery and long-term follow-up.

The Heart Center, staffed with emergency cardiologists 24 hours a day, offers emergency services. After treatment, we offer rehabilitation services carried out by specialists and physiotherapists to reduce the risk of future complications.

• Holistic Approach: Our approach to heart healthcare covers prevention and early detection, ensuring comprehensive care throughout.
• Global Expertise: Our experienced cardiologists have studied at reputable institutions worldwide, including the USA, UK, Canada, Australia, and other countries.
• Diverse Specializations: Areas of expertise cover all fields, including specialists in cardiac catheterization, cardiac electrophysiology, cardiology, and more.
• Patient Volume: We care for more than 6,700 inpatient and outpatient heart cases annually, emphasizing personalized attention and care.
• Comprehensive Services: Our services encompass various procedures, including balloon angioplasty, stent placement, radiofrequency catheter ablation, and over 300 cardiac surgeries each year.
• Cutting-Edge Facilities: Our state-of-the-art operating room and Cath Lab, strategically designed to be adjacent to the operating room, are equipped with the latest medical technology.

Choose Samitivej Hospital in Bangkok, Thailand, where our dedicated cardiologists and comprehensive services ensure the highest standard of patient treatment and heart care.