Transcatheter Aortic Valve Implantation (TAVI)

Transcatheter aortic valve implantation (TAVI) has evolved from novel technology to mainstream therapy in only a few years (Fig. 1.1). The first randomized trial was published in 2010 and 5 years on TAVI is available in more than 65 countries around the world, more than 200,000 valves have been implanted, and estimated global growth is projected to quadruple over the next 10 years. Valve sizing and positioning are crucial and require integration of information regarding type of valve being implanted, route of implantation, underlying anatomy of aortic valve and coronary artery origins, operator experience, and cardiac imaging techniques (Figs. 1.2 and 1.3). Procedures can be performed under a general anaesthetic with guidance from transoesophageal echocardiography (TOE) and 95 % of patients are extubated in the catheter laboratory. Transfemoral TAVI can also be performed using conscious sedation and local anaesthetic without TOE and in some countries this is the preferred technique. We present a case of TAVI performed in the United Kingdom (UK) in 2012 under general anaesthetic (available to view at www.mici.education).