TRANSCATHETERAORTICVALVEIMPLANTATIONINFORMATIONLEAFLET
CompiledbytheTAVIteam.August2016.ForqueriescontactHelenJackson01865223279.ForreviewAugust2017.
TRANSCATHETERAORTICVALVEIMPLANTATION(TAVI)
PATIENTINFORMATIONLEAFLETOXFORDHEARTCENTRE
TRANSCATHETERAORTICVALVEIMPLANTATIONINFORMATIONLEAFLET
CompiledbytheTAVIteam.August2016.ForqueriescontactHelenJackson01865223279.ForreviewAugust2017.
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
TRANSCATHETERAORTICVALVEIMPLANTATIONINFORMATIONLEAFLET
CompiledbytheTAVIteam.August2016.ForqueriescontactHelenJackson01865223279.ForreviewAugust2017.
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)
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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
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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:
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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
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• 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.
TRANSCATHETERAORTICVALVEIMPLANTATIONINFORMATIONLEAFLET
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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.
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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
TRANSCATHETERAORTICVALVEIMPLANTATIONINFORMATIONLEAFLET
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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.
TRANSCATHETERAORTICVALVEIMPLANTATIONINFORMATIONLEAFLET
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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.
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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.
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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
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CompiledbytheTAVIteam.August2016.ForqueriescontactHelenJackson01865223279.ForreviewAugust2017.
WhocanIcontactwithmyqueries?
Typeofquery WhotocontactGeneralqueriesregardingTAVI [email protected]:
1) ProfessorAdrianBanningor
2) DrJimNewton
3) ProfessorRajeshKharbanda
KiriHolmes,PersonalAssistant
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