TAVI & MitraClip

TAVI

The TAVI procedure is used to treat aortic stenosis (narrowing of the aorta). One of the four heart valves is called the aortic valve, which is situated at the top of the left ventricle and leads to the aorta (the major blood vessel that circulates oxygenated blood around your body). If aortic stenosis occurs, this means that the aortic valve cannot open fully, which leads to a restriction in blood flow and forces the heart to work harder to pump blood through.

The TAVI procedure involves inserting a new valve on top of the old, damaged valve. The procedure usually takes one to two hours and is carried out under local anaesthetic (meaning you are awake but don’t feel anything). Generally, patients will come to the hospital on the day of the TAVI procedure and stay in for between two and five days.

TAVI is performed by an interventional cardiologist. During the procedure, the doctor makes a small incision in the groin or under the collarbone. A small tube (catheter) with a balloon tip is then inserted into the artery at the groin or shoulder. This catheter is then passed into the heart via the artery and the doctor positions it in the opening of the aortic valve. Once in place, the doctor gently inflates the balloon to make space for the new tissue valve. The new valve is passed through the catheter and placed on top of the old, malfunctioning valve. The new valve expands to fill the space. The balloon is then deflated and the catheter and balloon are removed, leaving the new valve in place.

Recovery from the procedure is usually quick, patients are usually sitting out of bed the day after the procedure. Pain killers can be given to reduce and post-procedural pain. Most patients return home within a few days of the TAVI procedure. It can take 2-3 months for a full recovery but this varies greatly from one patient to another.

Your cardiologist will discuss the benefits and risks of the procedure beforehand. TAVI is a relatively new procedure with promising results, however, because it is new there is limited information on long term results.

MitraClip

MitraClip is a less invasive mitral valve regurgitation treatment option. Before MitraClip was available, the only treatment option for mitral regurgitation was mitral valve surgery which is performed as traditional open heart surgery.

MitraClip however is:

• Less invasive
• Associated with faster recovery times with patients often returning home 2-3 days after the procedure

How does it work and how is it different to more traditional methods of surgery?

Unlike the traditional repair surgery, the MitraClip procedure doesn't need the chest to be opened. The doctors access the faulty mitral valve via a catheter (long thin tube) which is fed up to the heart from a vein in the leg.

The doctor uses image guidance to feed the catheter up the veins from the groin to the heart to gain access to the mitral valve.

The MitraClip (the device used to repair the valve) is then also fed along the catheter and into the heart chamber - just above the faulty valve. The MitraClip is then moved from the atrium into the ventricle - through the faulty valve. It is then pulled backwards gently to hold the flaps of the valve. The clip holds the centre of the valve together to stop the flapping which is causing the regurgitation.

Imaging of the heart is used throughout the procedure to make sure the clip is in the best place for the valve to work efficiently. Once the position is correct the clip is locked in place and the access catheter is removed.

The MitraClip will stay in situ and fibrous tissue will grow around it. The MitraClip (Abbott website) has a great video explaining how the procedure works.