Percutaneous Aortic Valve Replacement (PAVR)
About this service
Percutaneous aortic valve replacement is the replacement of the native aortic valve in your heart with an artificial valve.
The aortic valve
There are four valves in your heart. The aortic valve is situated just where the main blood vessel, the aorta, leaves your heart. This valve has leaflets that open and close to stop blood from flowing backwards. The valves in the heart can develop different problems. One of these problems is called aortic stenosis.
Aortic stenosis is when the aortic valve becomes narrowed. This may be mild, moderate, severe or critical. When the aortic valve is narrowed the blood flow through the valve is reduced, putting the heart under a lot of stress and strain. Severe or critical stenosis can cause symptoms such as increasing shortness of breath, dizziness, blackouts or chest pain.
The main cause of aortic stenosis is related to deposits of calcium on the valve leaflets.
Aortic stenosis diagnosis and treatment
Aortic stenosis is diagnosed based on patient history, physical examination and special cardiac tests including an ECG, echocardiogram and angiogram. For most patients, the aortic valve is replaced by open heart surgery. However, for patients for whom the risks of open heart surgery are too high, the percutaneous aortic valve replacement procedure is considered more suitable, as it is less invasive.
This procedure is usually reserved for patients for whom open heart surgery is considered too risky due to age or other underlying medical conditions.
You are usually admitted to hospital the day before the procedure. If you are on blood thinning medication you may be asked to stop taking these for a few days before admission. You will be seen by your consultant and have some routine blood tests.
In total, you may be required to stay in hospital for three to five days.
Accessing the valve
The procedure is done in the cardiac catheterisation laboratory (cath lab). It is performed under general anaesthetic, which means you will be asleep and experience no pain during the procedure.
The aortic valve is accessed through an insertion in the groin or a small incision between your ribs on the left side.
A catheter (plastic coated wire) is placed in the femoral artery (in the groin) or through the ribs and guided into the chambers of the heart. A compressed tissue heart valve is placed on the balloon catheter and positioned directly inside the diseased aortic valve. Once in position, the balloon is inflated to secure the valve in place.
- You will be transferred to the intensive care unit (ICU) where you may be on a ventilator to help you to breathe overnight.
- You may have a chest drain if an incision was made through your ribs.
- Your stay in hospital will be between 7 -10 days, but each patient is reviewed and assessed individually and your doctor will decide when you are ready to go home.
- Any changes to your medication will be discussed with you and your family, prior to leaving hospital.