transcatheter aortic valve implantation … · left breast and directly into the heart. this is...

TRANSCATHETERAORTICVALVEIMPLANTATIONINFORMATIONLEAFLET

CompiledbytheTAVIteam.August2016.ForqueriescontactHelenJackson01865223279.ForreviewAugust2017.

TRANSCATHETERAORTICVALVEIMPLANTATION(TAVI)

PATIENTINFORMATIONLEAFLETOXFORDHEARTCENTRE



Contents Page

WhatisTAVI? 3

Whatisaorticstenosis? 3

TypicalpathwayforapatientreferredtotheTAVIteam 4

WhatvalveisusedforaTAVI? 5

HowisaTAVIvalveinserted? 5

WhathappensifImightbesuitableforaTAVIprocedure? 5

WhathappensaftertheTAVIclinic? 6

Whathappensduringtheassessmentadmission? 6

WhatifIhavealreadyhadsomeofthesetestsbefore? 7

Whathappensafterthetests? 7

WhathappensduringaTAVIprocedure? 7

WhathappensafteraTAVIprocedure? 9

Whatarethepotentialbenefitsofvalveimplantation? 9

Whatarethepotentialrisksoftheprocedure? 9

Whatarethepotentialrisksofnothavingtheprocedure? 10

WhatcanIdotoimprovemyhealthbeforeaTAVIprocedure? 10

RecoveringfromaTAVIprocedure 10

WillIhaveafollow-upappointment? 13

WherecanIgetmoreinformation? 13

WhocanIcontactwithmyqueries? 14



WhatisTAVI?

Youhavebeendiagnosedwithaconditioncalledaorticstenosis–anarrowingoftheaorticvalve

oftheheart.Yourcardiologisthasdecidedyoumaybenefitfromtreatmenttoreplacethevalve.

However, due to your overallmedical condition you are at higher risk of complications from

conventionalsurgerytoreplacethevalve.

You are being considered for a newer type of treatment where a catheter (plastic tube) is

insertedintotheheartviaasmallincisionandanewvalveimplantedinsidetheoldvalve.The

medicalnameforthisprocedureisTranscatheterAorticValveImplantation,orTAVI.

Patients being considered for treatment of aortic stenosis require careful and thorough

assessmenttoensurethebestpossibletreatmentisprovided.

ItisimportanttounderstandthatnotallpatientsreferredforconsiderationofaTAVIprocedure

byanothercardiologistorcardiacsurgeonwillbeabletohavetheprocedure.Reasonsforthis

mayinclude:

• YourownvalvebeingeithertoolargeortoosmallforaTranscathetervalvetosafelyfit

inside

• Technicalreasonswhytheprocedurecannotbeperformedatanacceptablelevelofrisk

• Additional medical problems likely to either significantly increase the risk of the

procedure or significantly reduce the likely chance of the procedure improving

symptomsandqualityoflife

Whatisaorticstenosis?Theheartcontainsfourvalves,whichmakesurebloodflowsinthecorrectdirectionoutofthe

pumpingchambers.Theaorticvalveisanoutletvalveontheleftsideoftheheartwhichopens

toallowbloodtoflowoutoftheheartandaroundthebody.

Aortic stenosis describes a narrowed valve which opens less easily and it is harder for the

hearttopushbloodoutandaroundthebody.

Aorticstenosisisusuallycausedby‘wearandtear’ofthevalve,andlesscommonlyduetothe

valvebeingabnormalatbirth,orfollowinginfectionsuchasrheumaticfever.

Theextraworkplacedontheheartcancausebreathlessness,fluidretention,chestpain,dizzy

spellsorblackouts.

NormalvalveNarrowedvalve(stenosis)



TypicalpathwayforapatientreferredtotheTAVIteam

*Balloon valvuloplasty is stretchingof theaortic valvewith aballoon. Theeffect is only short

term.

It usually takes between 10 – 12 weeks from being seen in the TAVI clinic to a decision on

treatmentbeingmade.IfTAVIisrecommendedthentypicallythiswouldbeperformedaftera

further10-12weeks.

ReferredtoTAVIteam

SeeninTAVIoutpacentclinic

Admidedtoassessmentinvescgacons

(wardordaycase)

ResultsdiscussedinTAVIteammeecng

AdmidedforTAVIprocedure

Medicaltherapyrecommendedpossiblyincludingballoon

valvuloplasty*

Furtherinvescgaconsneeded

Surgicalaorccvalvereplacement

Medicaltherapyrecommended



WhattypeofvalveisusedforaTAVI?

WeusetheLotusvalveformostpatientsandtheEdwardsSapienvalveforothers.ThepicturebelowontheleftistheEdwards‘Sapien’valve.Thevalveismadeofinertbiologicalmaterialfromacowmountedonastainlesssteelstent(meshframe)whichisthensquasheddowntoasmallsizeoverasmallballoon.ThepictureontherightistheBostonScientific‘Lotus’valve(photographprovidedcourtesyofBostonScientific©BostonScientific2015-donotcopyordistribute).

HowisaTAVIvalveinserted?The procedure is carried out under sedation if via the femoral artery, and under a general

anaestheticforallotherapproaches.

Thesmallcompressedvalve is insertedviaasmallcatheter(plastictube) intotheheart.Thereare

threewaystheprocedureisperformed:

1. Transfemoralapproach–thetube is insertedviasmall incision intoa largebloodvesselat

thetopofthegroin(thefemoralartery)whichleadsuptotheheart

2. Transapicalapproach–thetubeisinsertedthroughanincisiononthechestwallunderthe

leftbreastanddirectlyintotheheart.Thisisusedifthefemoralarteryisnotbigenoughfor

atransfemoralapproach

3. Transaorticapproach–asmallcut ismadethroughtheupperpartofthebreastboneand

thecatheterpasseddirectlyintotheaortaandthenonintotheheart

Theexactprocedureuseddependsuponthesizeofyourfemoralarteriesandwhetherthereisany

significant ‘furring up’ (calcification) of the femoral artery or the main blood vessel of the body

(aorta).

WhathappensifmydoctorthinksImightbesuitableforaTAVIprocedure?

ThefirststepformanypatientsistobereferredforreviewintheTAVIclinicwheretheywillbeseen

byoneofourconsultants.Thepurposeofthisclinicistoassessthefollowing:



1. Isaorticstenosisthemainproblem?

2. Isaorticstenosisthecauseofsymptoms?

3. IsitappropriatetoconsidertreatmentincludingTAVI?

4. Whatinvestigationsareneedednext?

5. Isanytreatmenttothevalverequiredurgently?

Itisimportanttoknowthatatthispointitmaybecleartothe

ConsultantthatTAVIisnotsuitableforyouandifthatisthecase

thereasonswillbeexplained.

WhathappensaftertheTAVIclinic?Ifanadmissiontothecardiologywardforinvestigationsisrequiredthenanadmissiondateforthese

investigationswillbepostedouttoyou.Typicallythiswillbearound6–8weeksaftertheclinicvisit.

Somepatientsrequireadditionalclinicvisitstomonitorprogressorseekadditionalinformationfrom

otherspecialistsinvolvedinyourcare.

Whathappensduringtheassessmentadmission?

Youwillusuallybeadmittedfortestwhichmayinclude:

• Generalphysicalexamination• Routinebloodtests

o Kidneyandliverfunctiono Haemoglobintoexcludeanaemiao Bloodclotting

• ChestX-Ray• AnECG(recordingoftheheartelectricalactivity)• Anechocardiogram(anultrasoundexaminationoftheheart)

o Thismaybeperformedbyeitherplacingtheultrasoundprobeonthechestwallorpassingasmallprobeintotheoesophagus(gullet)undersedation-thisusuallytakesbetween10-30minutes

• Acoronaryangiogramo Thisisaprocedureunderlocalanaestheticwhereasmallplastictubeisinsertedinto

the femoral artery at the top of the groin and passed to the heart under X-Rayguidance

o A special dye is injected to show up areas of the heart including the coronaryarteries,aortaandthefemoralartery

o Theproceduretakes30minutesandattheendthetubeisremovedandthearterygentlypresseduntilthesmallholehassealed

• Discussionwithasurgeono As surgical aortic valve replacement isoftenabetter treatment foraortic stenosis

thanTAVIallpatientsmustbeseenbyasurgeon



• Itisveryimportanttohavegooddentalhygienetominimizetheriskofinfectionofaheartvalve-ifyouhavenothadarecentdentalcheckupthiswillbeorganizedandanytreatmentneededarranged

• Itmightbenecessarytohavelungfunctiontestsandascanofthebloodvessels(arteries)intheneck

WhatifIhavealreadyhadsomeofthesetestsbefore?Oftenroutinetestssuchasacoronaryangiogramorechocardiogramhavealreadybeenperformed.

Toavoidunnecessaryduplicationoftestswewillobtaintheresultsoftheseanddecideifarepeat

assessmentisneeded.

Ifyouonlyneedoneortwofurtherteststocompleteyourassessmentthismightbearrangedviaa

single visit to our day caseward if youhave appropriate transport and care ondischarge already

available

Whathappensafterthetests?

Oncethetestshavebeencompletedyouwillbedischargedhome.

The TAVI team meets weekly to review all cases in detail. All of the results from the tests are

reviewed and discussed. The team then decides what the best treatment option is and thismay

include:

1. Surgicalaorticvalvereplacement

2. Transcatheteraorticvalvereplacement

3. Medicaltreatmentwithmedicationsonly

4. Additionalinvestigations

5. Atemporarystretchofthevalvewithaballoon(BalloonAorticValvuloplasty)

AdditionalinvestigationsmightincludeaspecialCTscantoevaluatetheaortaandotherarteriesin

moredetail,oranMRIscanofthehearttoassesstheheartmusclefunction,orastressechowhere

the heart is assessed at rest and after simulated exercise using drug stimulation. Detailed

assessmentoflungfunctionisalsooftenneededforpatientswithrespiratoryproblems.

Oncetheteamhavedecidedonthebestoptiona letterwillbesent toyouandyourGP(andany

otherdoctors involved inyourcare)explainingthedecisionandwhathappensnext.Oftenwewill

ringyoupersonallytoexplainthedecisionoftheteam.Youmaybecontactedbyamemberofour

researchteamforfurtherdiscussion.

WhathappensduringaTAVIprocedure?Immediatelybeforetheprocedureyouwillhavesomelocalanaestheticinyourwristandacannula

(a small tube)will be inserted into an artery to allow closemonitoring of your blood pressure. If

beingperformedundergeneralanaestheticyouwillalsohaveadripinsertedintoaveininyourneck

formonitoringpurposesandtoallowmedicationand/orfluidstobegiventoyoueasily.Youmay

alsohaveaurinarycatheterinsertedintoyourbladdersothatyoucanpassurinefreelyintoabag.



Theaimwillbetoremoveallofthesethefollowingdayorsooner,dependingonyourprogress. If

theprocedureisperformedundersedationthenthesearenotnormallyneeded.

TheTAVIprocedurewillbeperformed inacardiaccatheterisation laboratoryusingfluoroscopy(x-

rays)andechocardiography(ultrasoundoftheheart) forvisualization.Thedurationof fluoroscopy

that you receive should not be more than 20 minutes. The aim of these procedures is to avoid

prolonged,deepanaesthesiaandopen-heartsurgerywhichrequirealongerrecoveryperiod.

Ifyouarehavingthetransfemoralapproach

TheprocedureisperformedbyaCardiologistthroughasmallpunctureinyourfemoralarteryatthe

top of the leg. A vascular surgeon who has specific expertise in this type of procedure will be

availableshouldproblemsarise.

Theprocedure isdesignedto improveyourheart function,withoutrequiringremovalofyourown

narrowed aortic valve. Before implantation, the narrowed aortic valvemay need to be stretched

open by inflating a balloon on the catheter (this is called balloon aortic valvuloplasty). The

replacement valvewill be carefully crimped (compressed) andmounted onto a delivery catheter,

using a specially designed device. Itwill then be inserted into the femoral artery in your leg and

delivered to theheart.The replacementvalvewill thenbeexpanded to fitacrossyourownaortic

valve,holdingitopenpermanently.Thepuncturesiteinyourgroinisclosedusingspecialstitches.

Ifyouarehavingatransapicalortransaortic(surgical)approach

Theprocedure is performedby theCardiac Surgeon, assistedby theCardiologist, througha small

incision(thoracotomy)eitherontheleftsideofyourchestallowingthesurgeontoaccesstheapex

(tip)ofyourheart–thetransapicalapproach.Alternativelyasmallcut ismadethroughtheupper

partofthebreastboneandthecatheterpasseddirectlyintotheaortaandthenonintotheheart–

thetransaorticapproach.

Thereplacementvalvewillbecarefullycrimped(compressed)andmountedontoaballoondelivery

catheter,usingaspeciallydesigneddevice.Thevalvewillthenbeinserteddirectlythroughthechest

wall,deliveredtothecorrectpositionandexpandedusingaballoontofitacrossthenarrowedaortic

valve,holdingitopenpermanently.Theballoonisthendeflatedandremoved,thepuncturesiteis

repairedbytheCardiacSurgeonandapleural(chest)draininserted.

Asthevalveisimplantedwewillspeedyourheartrateupto200beatsperminutewiththeuseofa

temporarypacingwire–thiswireisputinthroughaveininyourgroinorarmandpassedthrough

theveintotheheart.Anelectrical impulsewillthenbepassedthroughthewire inordertospeed

yourheartrateupforafewsecondsonly–thisreducesthebloodpressureandmotionoftheheart,

makingtheprocedureeasier.Oncethenewvalveis inplace,thepacingisstoppedandyourheart

ratewill return tonormal. Thepacingwire is then removed. In some circumstances a permanent

pacemakerisrequired.



WhathappensafteraTAVIprocedure?

If theprocedure is performedunder sedation youwill recover in the cardiac angiography suite, ifperformedundergeneralanaestheticyouwillgototheCardiothoracicCriticalCareUnit(CTCCU)forclose monitoring for a period ranging from hours to days depending on your particularcircumstances.Asyourecoverfromyouranaesthetic,yourbreathingtubewillberemovedassoonaspossible.Theaimistoremovethetubesinyourneck,wristandchestwithin24hourssothatyoucangetupandmovearound. If theprocedurewasperformedusing the transapicalor transaorticapproachyouwillbeprescribedacourseofantibiotics.

When you have recovered sufficiently you will be transferred to the Cardiology Ward orCardiothoracicWardtocontinueyourrecovery.Yourexpectedhospitalstaywillbebetween2–5days,dependingonyourprogress.Itisimportantthatyouhavesomeonetocareforyouforthefirstweekwhenyougohome.

AnonymousinformationrelatingtoyourTAVIprocedurewillbesubmittedtotheNationalOutcomesRegistryformonitoringandqualityassurancepurposes.

Yourdoctorwill likelyaskyoutotakeaspirinandclopidogrel(bloodthinningtablets)followingtheprocedureforatleastthreemonths–somepeoplewillrequirewarfarin.

Visitingtimes

Wehaveprotectedmealtimesforpatients.Visitorsarewelcomefrom9amto12middayand3pmto9pmontheCardiothoracicCriticalCareUnitandCardiologyWard.Visitingisfrom3pmto8pmontheCardiothoracicWard.Ifyouhaveaparticulardifficultywiththesevisitingtimespleasediscussthiswiththewardstaffwhowilltrytoaccommodateyou.

Whatarethepotentialbenefitsofvalveimplantation?Treatmentwiththenewvalveshouldimproveyoursymptoms.Itwillgiveyouamorenormalaortic

valveperformanceandimproveyouroverallheartfunction.Wewouldhopethiswill increaseyour

lifeexpectancyandimproveyourqualityoflife.

Whatarethepotentialrisksoftheprocedure?ImplantingaTAVIvalveisamajorprocedureandhasasignificantrisk.Wehaveperformedhundreds

of theseprocedures andwewill do everythingwe can tominimise these risks.However complex

procedureslikeTAVIarenevercompletelypredictableandit is importantthatyouandyourfamily

understandthisprocedure.Therisksinclude:

• Riskofdeathduringtheprocedureapproximately:5%(1in20peoplemightdieduringthe

procedure)

• Riskofheartattackorstroke5%.(1in20peoplemighthaveastrokeorheartattackduring

theprocedure)

• Riskof requiringapermanentpacemaker:30% (1 in3peoplemightneedapacemakeras

partoftheprocedure)

• Damagetogroinarteriesorbleedingorinfection:<5%

• Kidneyfailure(ifimpairedkidneyfunctionexistedpriortosurgery)rarely



THEOVERALLRISKOFDEATHORMAJORCOMPLICATIONDURINGORWITHINONEMONTHOF

PROCEDUREISAPPROXIMATELY5-10%

ATAVIwillonlyberecommendedifyourdoctorsfeelthisriskislowerthanconventionalaortic

valvereplacementsurgery.

Whataretherisksofnothavingtheprocedure?ATAVIisrecommendedifaorticstenosisiscausingsignificantsymptomsaswithoutanytreatment

these will usually continue to worsen and heart function starts to deteriorate, requiring more

medicationandmonitoring.

WhatcanIdotoimprovemyhealthbeforeaTAVIprocedure?

StopsmokingIf you smoke, you should try and stop completely or at least for several weeks before your

treatment. This reduces the risk of breathing problems and makes your anaesthetic safer. The

sooneryoustopsmoking, themore itwill reduceyourrisk.There isplentyofsupportavailableto

helpyougiveupforgood.PleasetalktoyourGP,pharmacistorcallSMOKEFREEon08000224332.

ControllingyourweightIf you are overweight, losing weight before your treatment will reduce many of the risks when

havingananaesthetic.

VisityourdentistVisityourdentisttomakesureyourteethandgumsareashealthyaspossibletoreducetheriskof

infection. If you have loose teeth or crowns, treatment from your dentistmay reduce the risk of

damagetoyourteethwhentheanaesthetistinsertsatubeintoyourthroattohelpyoubreathe.

VisityourGPIfyouhaveanyon-goingmedicalproblemssuchasdiabetes,asthma,bronchitis,thyroidproblemsor

highbloodpressure(hypertension),youshouldaskyourGPifyouneedacheck-up.Ifyoubecome

unwellwhenyouareduetocomeintohospital,pleasecontacttheCardiologyWardforadviceon

01865572675.

RecoveringfromaTAVIprocedure

WhenyouhavehadyourTAVIyouwillneedsomeonetocollectyoufromhospitalandwesuggestthattheystaywithyouforthefirstfewdaysafterdischarge.Thisisnotfornursingcarebutsothatifyoufeelunwellyouhavesomeonetohelpyou.Ifyoulivealonepleaseconsiderwhetheryoucouldask a familymember or friend to staywith you so that you could call them if you felt unwell, orwhetheryoucouldstaywiththem.Theywouldnotneedtobewithyouall thetime.Perhapsyouknowofalocalconvalescenthomeorcommunityhospital.Ifso,discussthesepossibilitieswithyourGeneralPractitioner.Everyone isdifferent so recovery timescanvary.As soonasyouarewalkingcomfortably around the home you can carry out light housework such as washing up, dusting,laundry, small amounts of ironing (while sitting down) and light weeding in the garden. None oftheseactivitiesshouldmakeyoufeelextremelybreathless–iftheydoyouareworkingtoohardandneedtoslowdown.



WillIneedtodoanyspecificexercises?Walking is the best form of exercise you can take following a TAVI and it is essential for your

recovery.Youmayfindthattheamountyoucanmanagevariesfromdaytoday.Youmayfeelalittle

‘washedout’andtiredandneedtorestintheafternoon.Forthefirstoneortwoweeksafteryour

surgery it is best toexercise little andoften.Beginbywalkingaround thehouseand taking short

walksoutside.Youmayfeelslightlyoutofbreathonwalkingatfirst,whichshouldimproveasyour

fitnesslevelincreases.

Onceyouarecomfortablewalkingon flatground, trywalkinguphillsslowly, restingasnecessary.After the first week at home aim for two 5 minute walks, one in the morning and one in theafternooneachday.Increasethisby1minuteperdayifitfeelscomfortabletodoso–youraimistobe able towalk for 30minutes, five days aweek. Youmay find this difficult if you havemobilityproblems,sojustdowhatyoucanmanageasitisimportanttobeasactiveaspossible.Youmaybeable tomanagemuchmore than this eventually if you do not have othermedical problems thatmight limit you. Always wait at least one hour after eating before you exercise, and plan yourexercise into your day to avoid taking on too much and tiring yourself out. You should avoidstrenuousactivityforsixweeks.This includesheavy liftinge.g.shopping,suitcases,orpushingandpullinge.g.cuttinggrass,heavygardeningandusingthevacuum.IfyouexperienceanyofthefollowingsymptomspleasecontactyourGPorNHS111:

• Chestpain.• Increasingshortnessofbreath.• Increasedswellinginyourankles• Anysignsofinfection(aredorinflamedwound,temperature,fever).

MedicationAswellasyournormalmedicinesincludingaspirin,youwillusuallybedischargedwithanadditional

bloodthinningmedicinecalledClopidogrel.Thiswillberequiredforatleastthreemonths.Afterthis

you will only need to take the aspirin. Some people may require warfarin or alternative

combinations.Youwillbedischargedwithsomepainkillerswhichwewouldrecommendyoutotake

regularlyuntilyouarenolongergettingdiscomfortfromyourwound.

TravellingafteryourprocedureTheDVLAadvises thatyoudonotdrive for fourweeksafteryourprocedure.Youdonotneed toinform the DVLA about your procedure, butwe do advise you to tell your insurance company inordertoavoidproblemswithanyclaimsyoumaymakeinthefuture.IfyouhaveproblemswithyourinsurancetheBritishHeartFoundation(BHF)willbeabletogiveyoudetailsofinsurancecompanies.YoucancalltheBHFon08450708070.Ifyouholdacommerciallicense,youwillneedtoinformtheDVLAwhowilladviseyoufurther.Providedyouhavehadnocomplications,youwillbeabletofly:

• oneweekafteryourTAVIifyouhadacutmadeinyourgroin• twoweeksafteryourTAVIifyouhadacutmadeinyourchest.

Despite this, if you are planning a holiday, itmay be better if youwait at least sixweeks beforetravelling,asitisunlikelythatyouwillgetthebestoutofyourbreakbeforethen.Ifyouwishtoflywithinthreemonthsofyourprocedure,checkwithyourdoctorandtheairlineaseachhasitsownprocedure. Also, remember to ensure that you have valid travel insurance – you can contact theBritishHeartFoundationforadvice.



AfterleavinghospitalAlthoughitislessinvasivethanhavingopenheartsurgery,havingaTAVIisasignificanteventandaswellasaffectingyourphysicalhealth,itcanaffectyouemotionally.Thisisanormalpartofrecoveryand these feelings will pass. Some people who have had a TAVI have reported the followingsymptomsorproblemsaftertheprocedure.Somearecausedbytheprocedureitselfandothersbytheanaesthetic. The symptomsareusually temporaryand settleover the first fewdaysorweeksaftertheprocedure.Altered sense of smell/strange taste in the mouth: This is caused by the anaesthetic and it iscommonforpeopletolosetheirappetite.Trytohavesmallmealslittleandoften.Blurredvision/dotsinfrontofeyes:Thisoccursasaresultofthesurgery.It isrecommendedthatyoudonothaveaneyetestwithinthefirstthreemonthsafteryoursurgerytoallowthistosettle.Nightmares/hallucinations or difficulty sleeping: Sleep disturbance is common following anyoperationandwillusuallysettleonceyouareathomeandgetbackintoyournormalroutine.Youmayfinditisinitiallybesttosleeponyourbackforcomfort.Muffledhearing/heightenedawarenessofheartbeat:Youmaybeparticularlyawareofthiswhenyou are lying on your side at night. Again, this is perfectly normal, but can cause concern. Try adifferentsleepingpatterntoseeifthishelps.Voicesoundsdifferentorhoarse:Thisoccursasaresultofthebreathingtubeweputinyourthroatduringtheoperation.Thiswillimproveovertime.Soreornumbbottom:Itisimportanttoremainasactiveasyoucanafteryoursurgeryandnotsitinonepositionforlongperiods.Constipation:Thiscanoccurasaresultofinactivityandthestrongpainkillersyouneedtotakeaftertheprocedure.Youcanaskusforalaxativetohelpthis.Pleasetellyournurseifyourbowelshavenotopenedbeforeyougohome.Loss of concentration/memory problems:Many people find they are unable to concentrate onthings like reading a book or newspaper. Be patient with yourself – as you recover yourconcentrationlevelswillreturntonormal.Arm, shoulderorwristpain/numbness:This canoccur as a result of the surgery. Thepositionofyourarmduringtheprocedurecansometimescausethistemporaryproblem.Ankleandlegswellinginbothlimbs:Thiscanoccurduringthefirstfewweeksafteryourprocedure.Itwill settle down, but you should speak to yourGP if it does not start to improve. If younoticeswellinginjustoneleg,seeyourGP. HowshouldIcareformywound?Youwillhaveanincision/scarinyourgroinoronyourchest,dependingonwherewemadethecuttoperformyourTAVI. Yourwounds shouldbehealedby the timeyou leavehospital, if they stillrequire a dressing wewill organise a District or Practice Nurse to continue this. The stitches aredissolvablesodonothavetoberemoved.Itisnormalforyourgrointobetenderforafewdaysandsometimescanbetenderforseveralweeks.Itisalsonormalforabruisetodevelop.Youcanshowerwhenyougethomebutavoid rubbing thewoundsite.Donothaveabathorusecreams, talcumpowderorsoapdirectlyontothegroinsiteforuptoaweekaftertheproceduretoavoidirritationandreducethelikelihoodofinfection.However,ifyounoticeanyofthefollowingpleasecontactyourGP:

• ahardtenderlumpundertheskinaroundtheareaofincision(althoughapea-sizedlumpisnormal)

• anyincreaseinpain,swelling,rednessand/ordischargeatthesite• acoldfootonthesamesideastheangiogram• araisedtemperature/fever.



If yourgroin starts tobleedyou shouldapplypressure to theareakeepingyour legas straightaspossible (lying down if you can). If the bleeding does not stop after 10minutes, dial 999. If thebleedingstopswithin10minuteskeepyourlegasstillaspossibleforthefollowinghour.Ifbleedingre-starts,gotoyourEmergencyDepartmentbutdonotdriveyourselfthere. WillIbeinpain?YoumayneedpainkillersforuptosixweekssoyoumayneedtogetmorefromyourGP.Takethesetabletsasdirecteduntil thepainbeginstoeaseandthenslowlyreducethedose.Youmaystillbetaking theodddose after sixweeks and this is perfectly normal. Thepain is normally around thewound,butcanalsobefeltaroundtheneck,shoulders,orback.Initiallythesideofyourchestmayfeelnumbtothetouch,butasthenerveendingsaroundthewoundbegintoknitbacktogether,youmayexperience tinglingorpinsandneedles. Youmayalsonotice sharp stabbingpainswhere thechestdrainwasifyourequiredone.Thesepainswilldiminishovertimeandpainkillersshouldhelp.Certainmovementssuchasraisingyourarmstogetsomethingoffashelforpickingsomethingupoffthefloormaycausesomediscomfortinitiallyanditisthereforebesttoavoidcertainactivitiestoallowyourchestwalltoheal.

WorkIfyouwereworkingbeforeyourprocedurethereisnoreasonwhyyoucannotreturntothisaftera

periodofrecoveryuptosixweeksifyouarefeelingwellandhavenoproblemwiththewound.You

donotneedtowaitforyourout-patientappointment.

WillIhaveafollow-upappointment?Afollow-upappointmentwillnormallybeorganisedforyouaroundtwotofourmonthsafteryourTAVI,whilst youare there youmayhavea chest scan knownas a trans-thoracic echocardiogram.Youwill receive notificationof this appointment by post. If youdonot receive your appointmentletterwithinthreemonthsof leavingthehospital,pleasecontactHelenJackson,ConsultantNursevia01865223067duringnormalworkinghours.Ondischargewewill giveyoua letterwhich listsyourtabletsandwhathappenedtoyouinhospital.AcopyofthiswillalsobesenttoyourGP.

YourquestionsforusPleasetakesometimetolistanyquestionsyouandyourfamilymighthavetohelpyourememberto

askthemwhenyouarenextatthehospital.

IfyouhaveanyqueriesfollowingyourdischargepleaseringHelenJackson,Consultant

Nurseon01865223067duringnormalworkinghours.

WherecanIgetmoreinformation?

NHSinformation:http://www.nhs.uk/conditions/aorticvalvereplacement/pages/alternatives.aspx

InformationontheEdwardsSapienValve:

www.edwards.com/products/transcathetervalve/Pages/THVcategory.aspx

http://newheartvalve.com/#sthash.QmTcDqwE.dpbs

TheBritishHeartValveSocietyhttp://www.bhvs.org.uk/information



WhocanIcontactwithmyqueries?

Typeofquery WhotocontactGeneralqueriesregardingTAVI [email protected]:

1) ProfessorAdrianBanningor

2) DrJimNewton

3) ProfessorRajeshKharbanda

KiriHolmes,PersonalAssistant

[email protected]

NatalieBrechin,PersonalAssistant

01865220325,[email protected]:

MrRanaSayeedorMrKrasopoulosKatharineNew,PersonalAssistant

01865572819,[email protected]

Awaitingnewsofappointmentdatesfor

investigationsoradmissionforTAVI

TheElectiveAccessTeam01865572810OR

HeartFailureTeamOfficeAdministrator

01865223067

Healthrelatedquestionswhilstawaiting

admissionforinvestigationsorTAVI

SeniorStaffNurses,CardiologyWard

01865231613

Healthrelatedquestionsfollowingdischarge HelenJackson,ConsultantNurse

viaHeartFailureTeamOfficeAdministrator

01865223067

transcatheter aortic valve implantation … · left breast and directly into the heart. this is...

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