Cardiology is the medical specialty focused on the heart and the cardiovascular system. It involves the diagnosis, treatment, and prevention of conditions affecting the heart and blood vessels. These conditions include coronary artery disease, heart failure, arrhythmias (irregular heartbeats), and valve disorders. The field covers a broad spectrum, from congenital heart defects present at birth to acquired conditions like heart attacks.
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Once the Heart Team has recommended TAVI and you have completed your pre-procedure testing, the focus shifts to the treatment itself. For many patients, the idea of having a heart valve replaced while awake (or lightly sedated) seems almost miraculous. The procedure is a blend of precision engineering and skilled medical hands. It is designed to be efficient, minimizing your hospital stay so you can return home quickly.
This section walks you through the entire treatment journey. We will cover the preparation for the big day, the step-by-step details of what happens in the procedure room, and the immediate recovery phase. We will also discuss cardiac rehabilitation, which is a vital but often overlooked part of the process. Understanding the timeline and what to expect each day helps reduce anxiety and allows you to participate actively in recovery. We perform about 90-95% of TAVI procedures in this manner.
Preparation usually begins a few days before the scheduled date. You will be given specific instructions about your medications. Most importantly, if you take blood thinners, you may need to stop them for a short period to reduce the risk of bleeding. You will also be told when to stop eating and drinking, typically from midnight the night before.
On the morning of the procedure, you will be admitted to the hospital. A nurse will shave the area where the catheter will be inserted (usually the groin) to keep it sterile. You will have an IV line placed in your arm to deliver fluids and medications. You will meet with your anesthesiologist to discuss the plan for keeping you comfortable. This appointment is the time to ask any final questions you might have.
Managing medications is crucial. While blood thinners are paused, other medicines, like those for blood pressure or heart rhythm, might be continued or adjusted. Diabetic patients will have a specific plan for their insulin or pills since they will be fasting.
Most TAVI procedures today are done under “conscious sedation” or “monitored anesthesia care.” This means you are medicated to make you very sleepy and relaxed, but you are not fully unconscious and do not need a breathing tube. You breathe on your own. However, in some complex cases, general anesthesia (being fully asleep) is still used.
The procedure takes place in a “hybrid operating room” or a catheterization lab. These rooms are equipped with high-tech X-ray cameras. You will lie on a narrow table. The doctor will inject local anesthetic to numb the skin at the access site in your leg.
First, the doctor inserts a sheath (a short tube) into the femoral artery. Through this sheath, a long, flexible guide wire is threaded up the aorta and across the narrowed valve. Next, a balloon catheter may be passed over the wire to the valve. It is inflated briefly to stretch the old valve open, making room for the new one. This step is called valvuloplasty.
Then, the TAVI valve, which is crimped tightly onto a delivery catheter, is guided into position. The doctor watches on the X-ray screen to ensure it is placed exactly in the middle of your old valve. Once positioned, the new valve is deployed. Depending on the type, it either expands on its own (self-expanding) or is expanded by a balloon (balloon-expandable). The new valve pushes the old leaflets aside and locks into place. The catheter is removed, and the small puncture in the leg is sealed.
The standard and preferred route for TAVI is the transfemoral approach. This uses the femoral artery, a large vessel in the groin. It is the least invasive method and offers the quickest recovery. We perform about 90-95% of TAVI procedures in this manner.
However, if the leg arteries are blocked or too small, the team uses alternative routes. The choice of access depends entirely on your specific anatomy shown on the CT scan. The goal is always to find the safest, straightest path to the heart.
This route is similar to having a heart angiogram. Because the artery is large and close to the skin, it is easy to access. After the procedure, the hole in the artery is closed with a special suture device or plug, so there is usually no need for surgical stitches on the skin.
The transaxillary approach (through the artery near the shoulder) and the transcarotid approach (through the neck) are two common options. In rare cases, a small cut is made between the ribs to get to the tip of the heart (transapical) or directly into the aorta (transaortic). These methods are more invasive and less common today.
After the procedure, you are moved to a recovery area or an intensive care unit (ICU) for observation. Unlike open surgery, you generally wake up very quickly. Nurses will monitor your heart rate, blood pressure, and the puncture site in your leg frequently.
They will check the pulses in your feet to ensure good blood flow to your legs. You will need to lie flat for a few hours to prevent bleeding from the groin access site. Within a few hours, you might be permitted to have a light meal and drink water. The focus is on ensuring the new valve is working correctly and that there are no complications like bleeding or heart rhythm issues.
The hospital stay for TAVI is remarkably short compared to surgery. Many patients are up and walking the same evening or the next morning. The typical hospital stay is 1 to 3 days.
Before discharge, you will have another echocardiogram to check the new valve. You will also have blood tests and a physical exam. Doctors want to make sure the puncture site is healing well and that your heart rhythm is stable. If everything looks good, you go home. You will need someone to drive you and preferably stay with you for the first few days.
Once home, recovery is about a gradual return to activity. You might feel worn out for the first week or two as your body adjusts to the new blood flow dynamics. You should avoid heavy lifting (usually anything over 10 pounds) for about a week to let the groin site heal fully.
Your doctor will likely prescribe cardiac rehabilitation. This is a supervised exercise and education program. It involves going to a gym-like setting where nurses and exercise physiologists monitor your heart while you exercise. It is the best way to rebuild confidence in your heart and physical strength safely.
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No, you should not feel pain. The local anesthetic numbs the leg, and the sedation keeps you relaxed and disconnected from the process. Although it is usually not painful, you may experience some pressure or pushing sensations.
The TAVI procedure itself typically takes about 1 to 2 hours. However, the preparation time before and the observation time immediately after mean you will be in the procedure area for longer.
Like any procedure, there are risks. These include bleeding at the access site, infection, stroke, or heart rhythm problems requiring a pacemaker. Your doctor will discuss these specific risks with you based on your health profile.
Many patients report feeling immediate relief from their shortness of breath as soon as they wake up. For others, energy levels return gradually over a few weeks as the heart muscle recovers and strengthens.
It is extremely rare for the valve to move once it is deployed. The pressure of the valve frame against the calcified native valve holds it very securely. Doctors verify the stability before they finish the procedure.
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