6th May 2025

Transcatheter valves

Transcatheter valves are those implanted through a catheter, most commonly in the aortic position. The benefit of these valves compared to those above is that they don’t require open cardiac surgery. As such, they can be considered in patients who have contraindications to surgery, including those with significant comorbidities and frailty. 

For the aortic TAVI there are a number of approaches, but transfemoral is overwhelmingly the most common. In this approach, a catheter is inserted into the femoral artery under local anaesthetic and sedation and fed retrogradely into the aortic position. Balloon valvuloplasty is performed, then under rapid pacing (to stop LV systolic flow displacing the new valve) a new valve is deployed in the aortic position and the catheter is removed. Newer versions of these valves are typically self-expandable. 

Given that they are performed under local anaesthetic and sedation, patients can typically be considered for discharge within 48 hours if there are no immediate complications. Common complications of TAVI can include conduction system abnormalities requiring need for pacing, alongside wound site issues with bleeding or infection. 

Subsequent to transcatheter aortic valve implantation, patients will typically be given a low dose single antiplatelet drug lifelong, commonly aspirin.