Transcatheter heart valve implantation

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure in which a new biological valve prosthesis is delivered to the heart using a thin catheter, most commonly via the femoral artery. The new valve is placed inside the damaged valve without removing the old one. The procedure is usually performed under local anesthesia – the patient is awake but does not feel pain. This procedure allows restoration of normal blood flow in the heart and improves quality of life in elderly patients and in patients with comorbidities for whom open-heart surgery would be too risky.

The aortic valve is located between the left ventricle of the heart and the body’s largest blood vessel, the aorta, and ensures the flow of oxygen-rich blood throughout the body. In the case of narrowing (stenosis), the valve does not open or close properly and blood flow into the aorta is obstructed. This may cause fatigue, shortness of breath, chest pain, dizziness, and may lead to heart failure or sudden death if left untreated.

More rarely, the mitral valve may be replaced via catheter. The mitral valve is located between the left atrium and the left ventricle and ensures one-way blood flow. If the mitral valve does not close completely (regurgitation or insufficiency), some blood flows backward; if the valve is narrowed (stenosis), the valve opening is reduced or blocked and blood flow is impaired. This may lead to complications such as atrial fibrillation, pulmonary hypertension, and heart failure.

PREPARATION FOR THE PROCEDURE AT HOME

Visit a dentist, as inflammatory foci in the oral cavity may enter the bloodstream due to bacterial spread and cause a life-threatening infection of the heart (endocarditis).
Keep blood pressure and blood glucose levels as stable as possible. Poorly controlled diabetes increases the risk of complications, including wound infections, impaired kidney function, and a longer hospital stay.
Stop smoking. Smoking and the use of e-cigarettes reduce blood oxygen levels, impair lung and vascular function, and slow wound healing, increasing the risk of infections and pulmonary complications. We recommend quitting at least 4 weeks in advance. If necessary, nicotine patches may be used, as they are safer for the procedure than smoking.
Please do not shave body hair yourself. On the morning of the procedure, the nurse will remove hair using a special hair clipper to prevent micro-injuries and reduce the risk of infection.
Please remove nail polish and gel nails to ensure accurate measurement of blood oxygen levels. Rings, including wedding rings, should be left at home.
Please come to the hospital in good health, without upper respiratory infections, exacerbation of chronic diseases, or skin infections. This helps ensure the safe and smooth course of the procedure.

Medication use at home before the procedure

Please discontinue blood-thinning medications according to the instructions of medical staff: Lixiana/edoxaban, Plavix/clopidogrel, Brilique/ticagrelor, Marevan/warfarin, Eliquis/apixaban, Xarelto/rivaroxaban – these increase the risk of bleeding during the procedure.
Take other medications according to your usual treatment regimen. For medication-related questions, please contact 731 8432 or 731 8433.

Please bring to the hospital:

Daily medications in original packaging; for patients with diabetes – insulin syringes, for asthma patients – inhalers, and for smokers – nicotine patches;
Necessary aids: hearing aid, CPAP device, walking stick;
Identification document (ID card or passport);
Personal hygiene items (toothbrush, toothpaste, shampoo if desired);
Light, non-slip slippers; pyjamas or a bathrobe if desired;
Mobile phone, charger, and headphones to avoid disturbing other patients.

Arrival at the hospital

Arrive at the hospital on the scheduled date between 08:00 and 10:00 and proceed to the department wearing outdoor clothing. We recommend that a family member or companion accompany you. A wheelchair can be obtained from the lobby if needed.
Upon arrival, first go to the registration desk (entrance from N. Lunini Street), from where you will be directed to the Department of Cardiac Surgery on the 3rd floor of Building J.
Do not eat in the morning; take medications (except those mentioned above) with water. In the case of diabetes, eat moderately in the morning and take medications according to your usual regimen.
The average hospital stay is approximately 7 days; the length of treatment may vary depending on the speed of recovery.
Please do not bring large amounts of cash or valuables.
Smoking and alcohol consumption are prohibited in the hospital.
Department patients may visit the café located on the 2nd floor and the R-Kiosk located on the 1st floor; patients may use the refrigerator and kettle in the department lounge.
Wards in the Department of Cardiac Surgery are double rooms.
At Tartu University Hospital, the inpatient daily fee is €5, payable for a maximum of 10 days of hospitalization.
If you have any questions or are unable to come to the hospital on the scheduled date, please call 731 8432 or 731 8433.

Information for relatives

Immediately after the procedure, information about the patient’s condition can be obtained from the intensive care unit by calling 731 8434. When completing documents, please designate one contact person who will relay information between the hospital and other family members and acquaintances. Visits to the intensive care unit must be arranged in advance with the staff using the same phone number. Please do not bring flowers to the intensive care unit and keep mobile phones on silent mode.
Recommended visiting hours are Mon–Fri 14:00–19:00 and Sat–Sun 10:00–17:00. Visitors are asked to leave outerwear in the cloakroom (open Mon–Fri 7:00–19:00, Sat–Sun 9:00–18:00). If your relative is staying in a general ward, information about their condition can be obtained from the duty nurse at 731 8433.

PRE- AND POST-PROCEDURE PERIOD IN THE HOSPITAL

The day before the procedure in the hospital

Upon arrival at the ward, the nurse will ask you to complete and sign the necessary documents (including a pre-anesthesia questionnaire regarding your health information), and required examinations will be performed: blood tests, ECG, measurement of vital signs, and X-ray. The physician will explain the details of the procedure and answer your questions.
You may eat and drink as usual.
Your personal belongings, including valuables, will be registered and stored in a safe and a locked storage area. They will be returned to you upon arrival in the general ward.
Before the procedure, empty your bowels, as post-procedural bed rest and medications may slow bowel function. A laxative will be provided if necessary.
Before going to sleep, wash your body and hair with antibacterial soap, then change into hospital pyjamas without underwear. A sleeping aid will be provided if necessary.

Before the procedure

Please wake up at 6:45 and take a shower; if necessary, the nurse will wake you. If you are second in line, take a shower at 8:30. Wash your body with antibacterial soap (do not wash your hair in the morning), put on clean hospital pyjamas without underwear, and brush your teeth.
Remove jewellery, contact lenses, and dental prostheses. Place dentures in a container and leave them on the bedside table. Do not use creams or cosmetics. Turn off your phone and place it in your bag.
On the morning of the procedure, do not eat, drink, chew gum, or smoke to avoid possible anesthesia-related complications. Necessary medications will be given by the nurse with a sip of water.
The required area will be shaved, after which you will be transported to the angiography room.

The procedure

The TAVI procedure usually lasts approximately 1–2 hours. During the procedure, you are generally awake, but sedative and pain-relieving medications are administered intravenously. The catheter insertion site (most commonly the femoral artery in the groin area) is locally anesthetized, so you will not feel pain. Mild pressure or discomfort may occur. The catheter introduced into the heart and the valve implantation itself do not cause pain, as there are no pain-sensitive nerves inside the heart lining.
Throughout the procedure, the angiography team continuously monitors your blood pressure, pulse, and blood oxygen levels.
Heart valve procedures may involve certain risks, such as vascular injury, heart rhythm disturbances, the need for pacemaker implantation, or stroke.

After the procedure in the hospital

After the procedure, you will be transferred to the cardiac surgery monitoring ward, where you will remain lying down until the following morning. Your general condition, blood pressure, heart rhythm, and possible bleeding from the puncture sites will be monitored, as the catheter was inserted through a large blood vessel (most commonly the femoral artery). During the first 3–6 hours after the procedure, pressure dressings are applied to the puncture sites to help close the artery, reduce the risk of bleeding, and prevent hematoma and pseudoaneurysm formation.
Your legs should remain straight. It is especially important that the hip and knee are not bent. If you feel discomfort, the staff will help adjust your position without bending your legs.
Mild bruising or swelling may occur at the puncture site; this is normal and usually resolves on its own. Tenderness or soreness in the groin area is expected; ask for pain medication if needed. Report severe pain or tension in the groin area to staff immediately.

POST-PROCEDURE PERIOD AT HOME

During the first days, you may experience fatigue, mild pain, or discomfort in the groin area. Get out of bed calmly and avoid sudden movements.
At night, especially when lying on your side, you may feel your heartbeat more strongly than before. This is normal – the new valve is working actively, and the heart may feel “louder” for some time. This sensation usually disappears over time.
The procedure may also affect your emotional well-being. It is normal to feel tired or exhausted, anxious, experience mood swings, or worry about your health and future. These feelings are part of the recovery process and usually pass over time. Talk about your feelings with family members or friends – sharing helps relieve tension. If you experience prolonged low mood, loss of interest, or sleep problems, contact your family doctor, who can refer you to a mental health specialist if necessary.
If possible, participate in cardiac rehabilitation, as it helps improve cardiac endurance in a supervised environment, develop muscle strength, balance, and walking ability; prevent falls; and increase independence in daily activities.
Full recovery usually takes 6–10 weeks, during which the heart adapts to the new valve, wounds heal, muscle strength returns, and you adjust to medications.
For 4 weeks, avoid lifting heavy objects (e.g. shopping bags, water containers); pulling and strenuous household chores (gardening, vacuuming); swimming, dancing, and cycling; and walking outdoors in very hot or cold weather.
Drink enough fluids, eat a protein- and fibre-rich diet (e.g. whole grains, vegetables), and gradually increase physical activity. If constipation occurs (which may result from reduced mobility and pain medication), ask the pharmacy for a laxative.

Wound care

Wash yourself at home under running water. In the shower, remove dressings from the wounds, do not direct the water stream directly onto the wounds, and do not use soap. Dry the wounds by gently patting with a clean towel. Due to the risk of infection, do not take baths, go swimming, or use a sauna until the wounds are completely healed.
Do not remove scabs yourself or rub the wound area.
Until the wounds have fully healed, clean them every other day with a non-irritating antiseptic and cover with a sterile dressing.
Once the scabs have fallen off, the wounds are healed and no dressing is needed.
Do not apply cream or powder to the wounds until they have healed.
Mild redness and swelling of the wound, bruising around the wound, a small amount of clear or yellowish discharge, and moderate tenderness at the puncture site may occur and are normal.

Medication use

Follow exactly the medication regimen prescribed by your treating physician, as stated in your hospital discharge summary. If you have questions about taking medications or experience side effects, contact your cardiologist or family doctor immediately. Keep your medication plan in a visible place. Do not change doses or stop taking medications without your doctor’s approval.

Physical activity

Recovery of overall muscle strength and mobility requires regular movement and rehabilitation. If you feel comfortable walking at home, do light household tasks such as washing dishes, dusting, or light weeding. Activities should not cause severe shortness of breath – rest if needed.
Start climbing stairs or walking uphill calmly. Mild shortness of breath is normal and improves as physical fitness returns.
Movement, especially walking, helps your body recover. It improves circulation, strengthens muscles, supports heart function, reduces the risk of complications such as blood clots, and helps restore usual physical capacity.
We recommend daily walks. Start calmly, for example with a 5–10 minute walk on level ground. Increase physical activity gradually according to how you feel. If movement is difficult, do as much as you are able.

Oral hygiene

Pay close attention to dental hygiene and visit a dentist once a year. Inform your dentist that you have had a heart valve replaced, as you will need antibiotics before dental procedures. Bacteria in the mouth can enter the bloodstream through the gums and infect heart tissue and valves, causing a dangerous heart infection (endocarditis).

Travelling

You may drive when you feel that your condition allows it.
When planning air travel, consult your treating physician; theoretically it is allowed one week after the procedure, but it is advisable to wait 4–6 weeks to avoid vascular complications and ensure stabilization of your general condition. Make sure you have valid travel insurance that also covers health risks related to cardiac procedures. The new valve does not activate metal detectors at security checks and does not damage the valve prosthesis. During flights, wear compression stockings due to the risk of thrombosis, drink enough fluids, and move regularly in the cabin.
When travelling long distances by car or train, it is important to stretch and walk every 1–2 hours and wear compression stockings to reduce the risk of thrombosis.

If you develop the following symptoms after the procedure, call 112 and inform them that you have undergone a transcatheter heart valve implantation (include the date of the procedure):

Signs of stroke: sudden partial paralysis of one side of the face, partial paralysis of one arm, speech disturbance, sudden numbness or tingling on one side of the body; sudden severe headache; swallowing or visual disturbances, balance problems, sudden confusion (difficulty understanding speech), difficulty speaking.
Signs of heart attack: chest pain, dizziness, fainting sensation, blurred vision, nausea and vomiting, pain or pressure in the back, jaw, abdomen, shoulder, or arm, worsening shortness of breath.
New or suddenly changed heart rhythm disturbance;
Bleeding from the wound or a rapidly enlarging bruise around the wound – if the groin area starts bleeding, apply firm pressure and keep the leg straight;
Skin colour changes (red, purple, dark brown, black); pain or swelling in the calf, knee, thigh, or groin.

If you develop the following symptoms after the procedure, contact your family doctor:

Wounds are more swollen than at discharge, or there is a hard and painful lump at the wound site (pea-sized is normal);
Increased wound pain, swelling, redness, or foul-smelling wound discharge;
Fever and chills;
Swelling of the ankles and legs;
Sudden weight gain.

Heart Clinic, Department of Cardiac Surgery
L. Puusepa 8, Tartu, 3rd floor, Building J

Doctors’ office: 731 8432
Duty nurses: 731 8433
Intensive Care Unit: 731 8434

Compiled by: Department of Cardiac Surgery
2026