Royal Papworth Hospital is recognised as one of the leading centres for transcatheter aortic valve implantation (TAVI).

Purpose of the procedure

The purpose of the transcatheter aortic valve implantation (TAVI) procedure is to replace the diseased aortic valve without open heart surgery via a minimally-invasive approach.

Aortic valve stenosis (narrowing) leads to obstruction of blood flow out of the heart. It is the most common form of acquired valvular heart disease in the UK, occurring in 2-4% of adults over 65 years old. It becomes more common with increasing age, so as our population grows older it will become more of a problem. This disease can cause many symptoms (exercise restriction, breathlessness, chest pain, collapse) as well as premature death. Frequent hospital admissions are often required and overall this can lead to a poor quality of life.

The only proven remedy for the relief of symptoms as well as improved survival is surgery to replace the valve. This is a very established technique with excellent long-term results. However, the risks of major complications or death are much higher in emergency operations, elderly patients, and in patients with concomitant coronary artery disease, kidney failure, and advanced heart failure.

Effects on patients

It is thought that at least one third of patients who could benefit from aortic valve implantation surgery do not receive it. The reasons for this are many. Some patients are deemed to be too high risk or too old whereas others never get referred to the appropriate specialist as it is felt they would not be suitable for an operation. A number of people simply do not wish to undergo major heart surgery.

What happens during the procedure

Royal Papworth Hospital offers a TAVI procedure which allows the aortic valve to be replaced without a major chest operation. New transcatheter technologies (where a valve is implanted through a small tube similar to keyhole surgery) mean a heart-lung bypass machine is not required as the operation can be carried out while the heart is beating.

In view of the aging population, and the increasing numbers of patients who could benefit from a more durable procedure, there has been more recent interest in the development of a percutaneously (through the skin) inserted heart valve, avoiding the need for a major operation. Royal Papworth Hospital has been collaborating very closely with Edwards Lifesciences who have developed a new type of valve which can be implanted via the leg arteries, or through a small incision underneath the left breast. The procedure involves passing a wire across the centre of the narrow valve.

This allows the introduction of the artificial SAPIEN™ aortic valve which is mounted and compressed onto a balloon. As the balloon is inflated it opens up the narrowed valve orifice consequently leading to relief of blood flow obstruction out of the heart.

In 2008, Papworth was one of the first centres in the world to offer this minimally invasive transcatheter valve implantation (TAVI). In 2018, Royal Papworth Hospital carried out its 500th TAVI. 

A team of more than 50 people have been involved with the introduction of this groundbreaking technique led by Dr Cameron Densem, Consultant Interventional Cardiologist. It has required a multidisciplinary approach and collaboration between many of the hospital departments. The unique position of Royal Papworth Hospital as a leading centre for cardiothoracic medicine has made it an ideal place to adopt these new treatments.