Transcatheter Aortic Valve Implantation (TAVI)
Transcatheter Aortic Valve Implantation (TAVI) is a procedure where the aortic valve in your heart is replaced without open heart surgery. It is a procedure for patients with a very narrow opening to their aortic valve, called aortic stenosis, who cannot have surgery. The valve is narrowed because of calcium build up and does not open and close very well. This makes the heart work harder. The new valve covers up the old one.
Not everyone with a narrow aortic valve can have TAVI. To have the procedure you must:
• Have severe build up of calcium on the valve.
• Have a valve size that is not too big or too small.
• Have blood vessels in your legs that are large enough for the tubes
(catheters) used to place the valve to pass through.
• Be able to take medicine to thin your blood after the procedure.
• Be unable to have open heart surgery to replace the valve.
Normal aortic valve Narrow aortic valve
(valve is open) (valve is open)
How Do I Know If I Can Have TAVI?
If you have a narrow aortic valve with calcium and might need a TAVI, you meet with a heart surgeon. The surgeon decides if you are able to have heart surgery to replace your valve. If surgery is not an option, you may still be able to have a TAVI.
You will also meet with a heart doctor (cardiologist). This doctor will discuss your options about your valve with you. Many tests will be done to help decide if TAVI is an option for you. These tests include:
• CT Angiogram of the Chest, Abdomen and Pelvis: This CT scan looks at the
size and shape of your blood vessels. It is also looking for any blockages in
the large blood vessels from your chest to your legs. You may or may not
receive contrast through your vein for this test. Your heart doctor will decide
if you need contrast.
• Transesophageal Echocardiogram: In this test the doctor uses ultrasound to
take pictures of your heart. A thin tube is put in your mouth and down your
throat to take the pictures. You will be given medicines to help you relax and
go to sleep for the test.
• Cardiac Catheterization: In this test the doctor puts a tube (catheter) into an
artery in your leg. You will be given medicines to help you relax and go to
sleep for the test. The tube goes up to your heart through the artery.
Contrast is used to check for any blockages in the arteries of your heart. If
any blockages are found, a stent might be used to push back the blockage
and open the artery.
TAVI Valve (made by Edwards Lifesciences LLC)
Preparing for Your TAVI Procedure HFFY
The day before your procedure you are admitted to the cardiac unit. You meet with your TAVI team to review the procedure and your care after the procedure. At this time, you are asked to sign a consent form for the procedure.
If you have a cold, fever, or do not feel well the day before you come to the hospital for TAVI, please call us at (608) 263-6400. Ask to speak with the “Cardiology Fellow on Call”. Be ready to give your name and phone number with area code in case this doctor needs to call you back. If you live out of the area, call 1-800-323-8942.
Steps for Getting Ready
1. Your heart doctor will ask you to stop taking some of your medicines.
Always follow what your doctor says about stopping and starting your
medicines.
• Stop taking all vitamins, herbs, and diet supplements, for 10-14 days before
and up to 7 days after your TAVI procedure.
• Stop taking Coumadin® 5 days before your TAVI procedure. Do not restart
this drug until told to do so by your doctor.
• It is okay to use acetaminophen (Tylenol®)
• Please be sure to take your dose of aspirin and anti-platelet medicines
clopidogrel (Plavix®) or prasugrel (Effient ) if you are already taking them.
• Your doctor will tell you which medicines to take before your TAVI procedure.
2. After midnight on the day of the procedure, do not eat or drink
anything. This includes water, ice chips, gum, candy, and chewing
tobacco. This prevents stomach contents from getting into your lungs while
you are asleep during surgery.
3. Stop drinking alcohol 3 days before your TAVI procedure. When mixed with
anesthesia, it can have serious effects on your body.
4. Stop smoking or at least cut back to reduce your risk.
5. Please remove all make-up and fingernail polish. This includes clear nail
polish.
6. Take your morning medicines that you have been told to take with a small
sip of water. Do not take potassium or vitamins since they may make you
sick on an empty stomach.
If you have diabetes, you will be given instructions about when to take your insulin or oral medicines.
7. Please leave all jewelry, rings, large sums of money, credit cards and other
valuable items at home.
8. Bring along any inhalers or CPAP equipment, eye glasses, eye drops,
hearing aids, dentures, prostheses, or other equipment that you will need
during recovery. Be sure these items are labeled with your name, if able.
9. You may bring pajamas, a robe, non-skid slippers, and other personal
items. All rooms are private and TVs are provided at no charge.
10. Bring a calling card or your cell phone if you wish to make long distance
calls. You may bring in your laptop. All of the rooms have wireless internet
access. It may be easier for you to leave your personal items in your
car until you have checked in. Once your room is ready, your family can
bring your things to you. The hospital is not responsible for lost or stolen
items.
Plan to stay in the hospital 5-10 days. When you leave the hospital, you will need to have someone drive you home and stay with you for at least the first 24 hours. It is helpful to plan ahead.
Questions about Getting Ready
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Important UW Hospital Phone Numbers
Admissions
To verify insurance ................................................................(608) 263-8770
For Billing questions ……………………............................................ (608) 262-2221
UW Hospital Paging Operator.................................................. (608) 263-6400
Toll Free Number..................................................................1-800-323-8942
Housing Accommodations.......................................................(608) 263-0315
First Day Surgery Unit........................................................... (608) 265-8857
UW Hospital Information Desk……………......................................(608) 263-6400
UW Hospital Outpatient Pharmacy (E5/236)..............................(608) 263-1280
Cardiac Intensive Care Unit (F4M5)……………………………………………. (608) 263-8715
General Cardiology Unit (F4/5)…………………………………………………… (608) 262-4011
UW Health Cardiovascular Medicine Clinic……..………………………….. (608) 263-1530
The Day of the Procedure
You will be taken to the Operating Room for your procedure. Your primary support will be guided to the Surgical Waiting Area on the 2nd floor. Here, they will be given updates from the Operating Room. They can also choose to get a pager or leave a cell phone number if they would like to leave the Surgical Waiting Area for a short time.
In the Operating Room
Once you are in the Operating Room, you meet your nurse and other staff who will answer your questions and make sure you are comfortable.
There will be ECG (electrocardiogram) patches on your chest, and a blood pressure cuff on your arm. A plastic clip on your finger will check your heartbeat and oxygen levels. The anesthesiologist will ask you to breathe oxygen through a soft plastic mask and medicines are given through the catheter in your vein (IV). After you are asleep, a breathing tube is placed in your windpipe to breathe for you. Other lines and monitors are added after you are asleep.
You will be in a deep sleep for the procedure (general anesthesia). The doctor makes a small cut in the artery in your leg and puts a tube in the artery. This tube will go up to your heart. A balloon is inflated in your narrow aortic valve to open it. Then the new valve is inflated over your valve. Your doctor checks to see the new valve is working. The tubes are taken out and the cut in your leg is closed with sutures, staples or surgical glue.
Valve in place (open) Valve in place (closed)
After the Procedure
Cardiac Intensive Care Unit (F4M5)
You are admitted to the Cardiac Medical Intensive Care Unit (ICU) from the Operating Room.
When you get to the ICU, you will have lines, drains, and monitors. You can expect to wake up shortly after getting to the unit. Even though you feel drowsy, you may hear beeps and alarms. The nurses will be checking on you often and nurses and doctors will ask you questions about how you feel.
Your primary support is updated during the procedure and told when you are going to the ICU. The ICU nurses need about 30 to 60 minutes to settle you into the ICU. Then, your primary support is brought in to see you, and may stay with you as long as you want. After 9 PM, your primary support will need to get a badge from your nurse.
Rest is important for good healing. Getting up and walking also helps you to heal. The day after surgery, you get out of bed to a chair for meals. Your nurse and physical therapist walk in the halls with you at least three times a day.
You can expect to be in the ICU for 1-2 days. From there, you go to the general cardiology unit.
General Cardiology (F4/5)
You stay in this room until you are ready to go home. You keep walking 3-5 times a day. The physical therapist will see you to do strength exercises. We continue to monitor your progress and control your pain. Your nurses keep track of the fluids that you drink. You can expect to have an IV and heart monitor until you go home.
Healthy Eating after TAVI
After your TAVI procedure, you may feel sick to your stomach. This is due to the anesthesia. You will slowly go from drinking liquids to eating soft foods. Some people lose their appetite and find that they have a taste like metal in their mouths. Eating healthy foods is important in healing. Small meals more often can help when you are not as hungry as usual.
If you have a special diet, a dietician will talk with you about a plan for learning more about your diet.
Going Home
You can expect to stay in the hospital 5-10 days. Before you leave, you will learn how to care for yourself. Plan for a friend or family member to be present the day you go home to hear instructions. You will receive prescriptions for medicines. Please bring your insurance card if you plan to fill your prescriptions at the UW Hospital Pharmacy.
Plan to leave in the afternoon. A family member or friend needs to drive you home and stay with you for 24 hours. It may be helpful to have someone stay with you for the first week or two after you go home. Our nurse case manager will help to arrange for any other needs like Home Health visits or a nursing home stay.
Questions about Going Home
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Caring for Yourself After TAVI
Your TAVI Procedure on _________________________ was through the
RIGHT / LEFT femoral artery.
If you have more questions after you are home, you may call the UW Health Cardiovascular Medicine Clinic at (608) 263-1530 between 8 AM and 5 PM Monday through Friday. At all other times, call UW Hospital Information Desk at (608) 263-6400 and ask for the “Cardiology Fellow on Call”. Be ready to give your name and phone number with area code in case this doctor needs to call you back. If you live out of the area, call 1-800-323-8942.
Care of the Site
If you have a poke (puncture) site, it is covered with a bandage for 3 days. The bandage is changed once a day.
If you have a cut at the site, there are a few layers of stitches holding your wound together on the inside. Your skin is closed on the outside with staples, sutures or surgical glue.
When you go home, please check the site twice a day for bleeding, swelling or pain. Once a day, clean the site gently with mild soap and water. Pat dry. Do not rub the site. Just allow the water to flow gently over the area. Leave it open to air unless your doctor or nurse tells you not to. Keep the site clean and dry to prevent infection.
If you have staples, they may be taken out at your first clinic visit (10-14 days after TAVI) and small pieces of tape called Steri-Strips may be placed along the cut to help support it for a few days. The strips will curl at the ends and fall off after a few days. If they do not, then you can gently take them off after one week.
What to expect at the site of the cut:
• It may feel sore or tender at the site for 1 week
• A bruise at the site that may take 2-3 weeks to go away
Activity
By the time you go home, you are able to do basic things like walking and taking a shower. Plan for extra time to rest. You may notice that you get tired more than before your TAVI procedure. This is normal. Your strength and energy level will increase as your body heals. It is good for you to walk and it is best to increase your walks slowly.
Here are some things to avoid in the first few weeks after you go home:
• Do not lift anything greater than 10 pounds for 2 weeks.
• Do not drive until your heart doctor says it is okay. This is usually not until
after the first clinic visit.
• Do not do contact sports or vigorous exercise.
Ask your doctor at your follow-up appointment when you may return to work
and resume sexual activity.
Pain Control
It is normal to have some pain in your leg where it was cut or poked. Your doctor may give you pain medicine for you to use at home. As your body heals, pain goes away and you will need less or no medicine for pain. Your pain may go away with an over-the-counter pain medicine such as acetaminophen. Do not take ibuprofen without talking to your heart doctor first.
Diet
Follow the diet you were given when you left the hospital. Less activity as well as some pain medicines can cause constipation. You can prevent this by eating foods high in fiber (whole grain breads and cereals and fresh fruits and vegetables). Drinking fluids can help if you have not been told to watch or decrease your fluid intake. If you are still constipated, you may use an over-the-counter stool softener or laxative. If this doesn’t help, call your primary care provider.
Medicines
You may be prescribed a medicine called Plavix® (clopidogrel) or Effient® (prasugrel) for some time after your TAVI procedure. Before you go home, make sure you have a prescription for one of these medicines. If you are not able to pay for this medicine, tell your nurse or pharmacist. Do not stop taking this medicine without talking to your heart doctor first.
Follow the list of medicines and when to take them that you were given when you went home. Tell your doctor of any side effects. Do not stop taking any medicine even if you feel better without talking to your doctor first.
When to Call for Help
Call 9-1-1 for emergency help if:
1. Any bleeding or sudden swelling at the cut in your leg. Put direct pressure
on the site. If the bleeding does not stop after 5 minutes of placing constant
pressure on the site, call 9-1-1 for emergency help. Keep pressing until
help comes.
2. Your leg becomes numb, cold, turns blue, or you have severe pain.
3. You have pain or pressure in your chest, arm, back or jaw.
4. You notice signs of a stroke. These are:
o Sudden numbness or weakness of your face, arm or leg. This is
often on one side of the body only.
o Sudden trouble seeing. This could happen in one or both eyes, oryou may have double vision.
o Not able to speak clearly or understand simple statements.
o Sudden trouble walking. This can include dizziness, loss of balanceor coordination.
o Sudden severe headache with no known cause. “The worstheadache of your life.”
If you have any one of these:
1. An increase in redness or warmth at the site of the cut, or red streaks on
your skin that extend from the cut.
2. Bulging or swelling at the cut.
3. More swelling in your legs than you have had before, or if the swelling does
not decrease after raising your legs over night.
4. New drainage or bleeding from the cut or open spots between the stitches
where the skin is pulling apart.
5. A temperature of more than 101.5 F (38.5 C) by mouth for 2 readings taken 4 hours apart.
6. If you notice the skin along the cut is getting darker or turning black.
7. Numbness in your foot or leg.
8. Your leg or foot starts to feel cooler when you touch it.
9. A change in the color of your leg. It becomes grey/white or bluish/purple.
10. A feeling like your heart is racing or palpitations in your chest.
Call the UW Health Cardiovascular Medicine Clinic at (608) 263-1530 between 8 AM and 5 PM. At all other times, call UW Hospital Information Desk at (608) 263-6400 and ask for the “Cardiology Fellow on Call”. Be ready to give your name and phone number with area code in case this doctor needs to call you back. If you live out of the area, call 1-800-323-8942.
Appointments with Your Doctors
If you have staples, you will see your primary health care provider 10-14 days after the TAVI procedure to have them removed.
You will need to have a check-up with the heart doctor that did your TAVI procedure in about 30 days and at 1 year after your procedure. You should also call or see your doctor any time you do not feel well.
Always let other doctors including dentists and eye doctors know about your heart valve replacement before any future procedures. Before having an MRI (magnetic resonance imaging) test, always let the doctor or medical technician know that you have an implanted heart valve. It may result in damage to the valve if the doctor does not know about it.
Appointments (Date, time, location and doctor/provider)
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Other Questions
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All pictures used with permission from Edwards Lifescience LLC.
Updated August 15, 2012 by Clinical Nurse Specialist- Cardiology
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 08/22/2012
Copyright © 08/22/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7405
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