What Is TAVI?
The TAVI procedure offers an alternative method of dealing with severe symptomatic aortic stenosis in patients where conventional open-heart surgery is not an option.
The advent of TAVI means patients, who until a few years ago could not be treated for this condition because of the risks attached to the treatment itself, can now be offered an intervention that has the potential to allow them to return to good health.
The procedure involves a replacement valve being fed through a small incision into the vascular system and into the heart. This approach avoids patients having their chests opened and often reduces the lengthy and difficult recuperation process from open heart surgery.
The National Institute for Clinical Excellence (NICE) has a Guideline (IPG 266) on the procedure accompanied by information for clinicians and patients.
Find the full guideline on the NICE website here. (Opens External Link)
Severe Aortic Stenosis
Aortic stenosis is the narrowing of the aortic valve in the heart, which results in restricted blood-flow causing the heart to work harder. It is a common condition, the most common valvular heart disease in western countries. The prevalence of aortic stenosis increases with age.
In mild cases aortic stenosis may not cause any symptoms, but in more severe cases it can cause serious symptoms and may lead to heart failure. It is a progressive condition and there is no medicine that can cure it or halt it's progression.
"The symptoms aren't nice. You get breathless, you get chest pain, you start having blackouts and you develop heart failure symptoms. Heart failure symptoms sound very medical, so what does that mean? Some patients have described it as feeling like have a bad over your face so you are suffocating. So when we are talking about aortic stenosis that's how my patients feel." - Cardiologist.
TAVI Across The UK And World
TAVI can be undertaken at any centre where cardiac surgery is routinely undertaken.
According to the UK TAVI Registry, the procedure has been undertaken in 21 centres in England, Wales and Northern Ireland (correct as of 14/12/10).
Pattients in the South Central England (Southampton and Oxford) Strategic Health Authority region are not currently funded by NHS Commissioners to undertake TAVI. The remaining Health regions of England fund the procedure. The centres in North West England (Manchester, Liverpool and Blackpool) have recently been told that the intervention will be funded.
Patients from North Wales and the Isle of Man receive TAVI in Liverpool.
There is no TAVI centre being funded by the NHS in Scotland.
A small number of patients from Scotland are beimg sent by their regional NHS Boards to receive treatment at English centres.
TAVI is funded for patients whose homes are in Wales. However, there is no centre funded by NHS Wales to undertake the procedure so all patients have to travel to centres in England to receive TAVI.
TAVI procedures have recently restarted in Belfast after a long period where no patients were being offered the intervention.
There are currently more than 40 countries offering TAVi, and in the majority of them they will undertake more interventions per head of population than here in the UK.