TAVI for Aortic Stenosis, Antalya | Prof. Dr. Umuttan Doğan

Aortic stenosis is treated by replacing the valve rather than repairing it. This is a mechanical problem: medicines can ease the symptoms, but they cannot open a narrowed valve. TAVI (transcatheter aortic valve implantation) places a new valve inside the old one, through a catheter passed up from the artery in the groin, without opening the chest. Who it is suitable for is not decided on any single measure, but on a thorough assessment.

What Is Aortic Stenosis?

The aortic valve is the door through which blood leaves the left ventricle for the rest of the body. It opens with every heartbeat and closes once the blood is through, so that none of it flows back.

When this valve narrows, the heart has to push the same amount of blood through at a much higher pressure. The muscle carries that load for a while and thickens. In time, this compensation is no longer enough.

Why Does Aortic Stenosis Develop?

Calcification with age. This is the commonest cause. The leaflets stiffen over the years and build up calcium.
A valve with two leaflets from birth. There are normally three. Where there are two, narrowing can appear at a younger age.
Rheumatic fever in the past. Less common now, but still a cause.

What Are the Symptoms of Aortic Stenosis?

The narrowing can progress quietly for years. Often the first sign is a murmur heard during an examination.

When symptoms do appear, they usually fall under three headings:

Breathlessness. On the stairs or uphill at first, then with lighter effort.
Chest pain or a feeling of pressure. Brought on by exertion, easing with rest.
Dizziness, greying of vision or fainting. Particularly during exertion.

Tiring easily, palpitations and swelling of the feet may come with them.

Why Not Wait Once Symptoms Have Started?

This is the most important thing on the page.

Aortic stenosis is a progressive condition. The moment symptoms appear, it means the heart has reached the limit of what it can compensate for. Putting off treatment from that point on is not advised.

Many patients put breathlessness down to their age, their weight or being tired. Thinking “I am old anyway, this is normal” delays the assessment. If you are breathless on exertion, feel pressure in the chest or become dizzy, do not treat it as a natural part of getting older.

How Is It Diagnosed?

Examination: aortic stenosis has a characteristic murmur, which can be heard with a stethoscope.
Echocardiography: this is the main test. It shows the opening area of the valve, the difference in pressure across it and the state of the heart muscle. The severity of the narrowing is established from these measurements.
ECG and chest X-ray: these give clues about the strain on the heart.
Exercise testing: in patients who say they have no symptoms, this can reveal their real capacity under controlled conditions.
Coronary angiography: before a valve procedure, the state of the coronary arteries is assessed as well; if there are narrowings, the treatment plan is built around that.

Why Isn’t Medication Enough in Aortic Stenosis?

This question comes up often in the clinic, and the answer should be clear.

Aortic stenosis is a mechanical problem. The valve has physically narrowed, and no medicine opens a narrowed valve. Blood pressure tablets, diuretics or heart failure medicines can ease the symptoms to a degree; they do not change the narrowing itself.

What is more, some medicines need care in aortic stenosis. Treatment that lowers the blood pressure too far can make it harder for blood to circulate beyond the narrowed valve. Your medication should therefore be adjusted under the care of a doctor.

In short: in aortic stenosis, medicines play a supporting role. If the valve is severely narrowed and symptoms have begun, the answer is to replace the valve. There are two ways of doing that: surgery through an opened chest, and TAVI through a catheter.

What Is TAVI?

TAVI stands for transcatheter aortic valve implantation.

The old valve is not removed. A new valve, folded onto the tip of a catheter, is carried into the middle of the narrowed one and opened there. As it opens, it pushes the old leaflets back against the wall and begins to work in their place.

The breastbone is not opened, the heart is not stopped and no heart-lung machine is used.

How Is TAVI Carried Out?

Planning Beforehand

TAVI takes longer to plan than to perform. This stage is skipped in most accounts of it, yet it decides the result.

Three-dimensional measurements are taken with a CT scan. They answer three questions:

What size of valve is needed? The diameter of the valve annulus — the ring the valve sits in — is measured to the millimetre. A valve chosen too small leaks; one chosen too large strains the ring.
Where are the openings of the coronary arteries? The new valve must not cover them as it settles.
Is the route in suitable? The diameter of the groin arteries and how much they bend are measured. If they are not suitable, another route is planned.

During the Procedure

It is usually done under local anaesthetic with light sedation; a general anaesthetic is not needed for every patient. The artery in the groin is entered, the catheter is advanced as far as the valve, the new valve is opened in place, and imaging confirms that it is working.

Where necessary, the old valve is first widened with a balloon so that the new one can seat properly. That step follows the same principle as balloon valvuloplasty.

The First Few Days Afterwards

You will spend a period in intensive care or under close observation. The heart rhythm is monitored continuously; the reason for this is explained in the section on risks below. The access site is checked and getting back on your feet is planned in stages.

How long you stay in hospital varies from person to person. You will be told what to expect in your own case.

TAVI or Open Surgery? Who Decides?

Both are used in the treatment of aortic stenosis, and neither is automatically the alternative to the other.

The following are considered together:

Your age and your expected life span
What risk surgery would carry for you
The size of the valve annulus and how the calcification is distributed
Whether the groin arteries are suitable
Whether there is disease in the coronary arteries as well
Any heart surgery you have had before
Your kidney function and your other conditions

This assessment is not made by one doctor alone. The decision is reached through a process in which cardiology and cardiac surgery give their views together, which is what international cardiology guidelines recommend. What you and your family prefer is part of that process.

Who Is TAVI For?

TAVI is considered in patients with severe aortic stenosis that needs treating. In its early years the method was used only in patients at very high surgical risk; over time its use has widened.

Situations that come up often:

Older patients, for whom open surgery carries a high risk
People who have had heart surgery before
Cases where lung, kidney or other organ disease raises the surgical risk
A surgically implanted tissue valve that has worn out over time (a valve-in-valve procedure)

When TAVI Is Not Suitable

If the valve annulus does not match the sizes of valve available
If the groin arteries are unsuitable and no alternative route can be found
If the problem at the valve is mainly leakage rather than narrowing, a different approach is needed
If there are other heart problems to be dealt with in the same session, surgery may suit better
If another condition markedly shortens expected life span, the benefit of the procedure is limited

Whether it suits you is decided after your test results and your general condition have been considered.

How Do You Prepare?

A few tests and a few practical preparations are needed before TAVI.

Imaging: echocardiography, a CT scan and, where needed, coronary angiography are completed. These determine the size of valve and the route in.
Dental check: dental health is assessed before a valve procedure. An untreated dental infection can be a risk to an implanted valve. This step is often skipped, and it matters.
Your list of medicines: bring all of them in writing, with their doses. Your doctor decides how blood thinners are managed around the procedure; do not stop them on your own.
Your kidney results: contrast dye is used during the procedure. Your kidney function is assessed beforehand and fluids are planned if needed.
Someone with you, and a plan for going home: having somebody with you in the first days afterwards makes things easier. If there are stairs at home, talk about that in advance.
Your questions: write down whatever is on your mind. The expected benefit, the possible risks and the alternatives are explained at the consultation beforehand, and your written consent is taken.

What Are the Possible Risks?

TAVI is an interventional procedure and carries certain risks. Knowing them lets you ask the right questions beforehand.

Rhythm and conduction problems. The new valve sits next to the heart’s electrical conduction pathway and can press on it. Some patients need a permanent pacemaker afterwards. This is why your rhythm is watched closely once the procedure is over.
Bleeding or injury to the vessel at the access site. The catheters used are thicker than those in coronary procedures.
Leakage around the valve. A small amount of blood may seep past the edge of the new valve. Most of the time this does not matter; if it is marked, an attempt is made to correct it in the same session.
Risk of stroke. As with every heart valve procedure.
Effects of the contrast dye on the kidneys. Your kidney function is assessed in advance.

These risks are weighed against the benefit expected from the procedure, and they are discussed in detail for your own situation at the consultation beforehand.

How Long Does the New Valve Last?

The valves used in TAVI are tissue valves. They do not call for lifelong blood-thinning medication as mechanical valves do, but they are expected to wear over time.

How long they last varies markedly from person to person; age, other conditions and the demands made on the valve all play a part. It would not be right to give a single figure.

What matters is this: if the valve narrows or begins to leak, in most cases a second valve can be placed inside the existing one. This is known as a valve-in-valve procedure. It is why regular echocardiography is not a formality — it is what allows a problem to be noticed early.

Life After the Procedure

Take the blood-thinning treatment your doctor has set out, regularly. Do not stop the medicines on your own.
Cardiology review and echocardiography are carried out at set intervals.
Always say that you have an implanted valve before any dental work or surgery. Precautions against infection may be needed.
Blood pressure, blood sugar and cholesterol continue to be managed.
Activity is increased in stages; a cardiac rehabilitation programme may be recommended.

If you notice a fever, weakness, worsening breathlessness, fainting or palpitations, see your doctor without waiting.

Treatment for Aortic Stenosis in Antalya

Prof. Dr. Umuttan Doğan is a cardiologist working in the interventional treatment of heart valve disease and in complex coronary procedures. TAVI is carried out in the catheter laboratory at Antalya American Hospital.

If your echocardiogram has shown aortic stenosis, or you are breathless on exertion, feel pressure in the chest or become dizzy, you can be seen at the clinic in Konyaaltı with the results you already have. For leaking mitral and tricuspid valves see TEER, and for other valve procedures the heart valve treatments page. You will find his background and contact details on their own pages.

Frequently Asked Questions

Is TAVI an operation? Will my chest be opened?

No. TAVI is carried out through the artery in the groin; the breastbone is not opened, the heart is not stopped and no heart-lung machine is used. It is usually done under local anaesthetic with light sedation. It is still an interventional procedure, with risks of its own.

I have aortic stenosis but no symptoms at all. Should I wait?

In patients without symptoms, the decision rests on the severity of the narrowing, the state of the heart muscle and the findings of an exercise test. For some people regular follow-up is the right course. But many patients reduce what they do without noticing — taking the lift instead of the stairs, for instance. So “I have no symptoms” is something to work out together with your doctor.

Will I need a pacemaker after TAVI?

Some patients do. The new valve sits next to the heart’s electrical conduction pathway and can press on it. That is why your rhythm is watched closely afterwards. This possibility is discussed with you before the procedure.

How long will the valve last? Will it need replacing again?

TAVI valves are tissue valves and are expected to wear over time. How long varies from person to person. If the valve narrows or begins to leak, in most cases a second valve can be placed inside it. This is why regular echocardiography matters.

TAVI or open surgery — who decides?

The decision is not made by one doctor. It is reached through a process in which cardiology and cardiac surgery assess the case together. Age, surgical risk, the measurements of the valve, the state of the arteries and other conditions are considered together, and your own preference is part of that process.

The information on this page is for general guidance and does not replace a consultation. Decisions about diagnosis and treatment are made by your doctor after assessing your own situation.