After ten years TAVI doubters have been persuaded that it works

Date: 03/05/2018

Cabrini’s heart team is marking ten years of a ground-breaking procedure – Transcatheter Aortic Valve Implantation (TAVI) – which has made life-saving treatment at lower risk available to many more patients.

WHAT IS TAVI? TAVI is a key-hole cardiac procedure that is less invasive than heart surgery and may be performed under sedation. TAVI is used to treat aortic stenosis which usually affects older people. The heart’s aortic valve flaps (leaflets) thicken and harden which reduces the flow of blood from the heart. As a result of having to pump harder, the heart muscle thickens and blood flow to the body and to the coronary arteries is restricted.

In a TAVI procedure, a catheter is used to insert the new valve through the groin using the femoral artery. This means a hole the size of a drinking straw, no stitches, and the valve starts working immediately.

Gerrit Veldhuis says he’s found the new normal. Just days after life-saving keyhole surgery on his heart, he was up and about and already seeing changes he’d never experienced after the two open-heart surgeries he’d had before.

Mr Veldhuis says he had 12 hours in surgery and spent two months recovering from open-heart surgery. But after his TAVI in February 2018, he was out of bed within 24 hours.

“It’s changed everything,” the 76 year old says. “Food tastes better and my appetite is back. I’ve put on weight. I can actually walk and now I can take my neighbour’s little dog out.”

It’s a huge change, his wife Arja Veldhuis explains. Before, if they went anywhere, “he couldn’t walk 20 metres. He’d be all puffed out and needed to sit down”.

Mr Veldhuis had a TAVI procedure at Cabrini Hospital in February. That’s a Transcatheter Aortic Valve Implantation, to replace a worn-out valve which affects the flow of blood to the heart.

His doctor is Dr Dion Stub, 39, an interventional cardiologist at Cabrini Health and the Chief Cardiologist for Ambulance Victoria. He was one of the first interventional cardiologists in Australia to learn the procedure from its founders in Canada, which is why marking its tenth year this year is something quite special.

Globally and in Australia over the last decade, hundreds of thousands of TAVI procedures have been performed. And ten years of TAVI procedures and trials has overturned the fears of many traditional cardiac surgeons who said the new procedure wasn’t safe. Now they work together in Cabrini Heart’s multi-disciplinary teams to ensure patients have the best advice and care, and get the operation which suits their needs and individual risk factors. Cabrini’s Heart team includes cardiologists, interventional cardiologists and cardiac surgeons.

The keyhole surgery is now covered by the health benefits scheme Medicare since late 2017, making it available to more people, especially those who are at risk with more invasive surgery.

And TAVI has proven to reduce the risks for many patients.

“We know unequivocally that having a TAVI is life-saving,” says Dr Stub. “Patients have a shorter procedure and they are back walking the same day. They go home in two to four days and in six, if they choose, they’re playing golf.”

When Gerrit Veldhuis couldn’t do any daily activities without puffing and resting, somebody said he’d be lucky if he could one day feel normal again. “I said I didn’t know what ‘normal’ was. Today I do know. It’s life-changing, even at my age.”

There are still some risks. After all, these surgeons and cardiologists are dealing with what is still a major life-threatening condition. Despite the advances in the last decade, people may still go on to need a pacemaker or develop a leak around the heart valve.

“The valves have improved in the least ten years,” Dr Stub says. “We’re using third generation valves and while the relative newness of the procedure means we don’t know the precise durability of the valves, that’s no different to the valves being used now for open-heart surgery. We also have better positioning of the valves, better valve performance and less leakage.”

We have also seen improvements in the procedure itself. For example, we used to make an eight to nine millimetre hole in the aorta and now it’s five.

And while the valve is still expensive at around $25,000 compared to up to $10,000 for a surgical valve for open-heart surgery, the fact that it’s a short procedure with only a few days in hospital means it compares favourably in cost to the high hospital costs of open-heart procedures. They can take a long time in the operating theatres, require intensive care nursing and a longer stay in a hospital bed.

“But the big deal is that we can help people who can’t have open heart surgery, or people who face a risk that’s just too great”, Dr Stub explains. Patients who are older, who have already had open heart surgery, or have been having radiation treatment for cancer are just a few examples of people we can help.

And there’s more progress to see. Australian experts are looking overseas and expecting the development of another generation of valves, and new research could find ways to protect people who may suffer the complications of stroke and heart attack.

Contact: Jackie Meiers Cabrini PR Manager 0419 009 146