Structural Heart Programme
Structural Heart Programme: Aortic Stenosis & TAVI
The Structural Heart Programme at CVSKL is a one-stop centre for screening, diagnosis, surveillance and treatment for all heart valve disease such as aortic stenosis.
Structure & function of the heart
Our heart consists of four chambers. There are two upper chambers called the left and right atrium, and two lower chambers called the left and right ventricles. Each chamber of the heart has one valve, making it four valves in total. The valves allow the blood to move through the heart in a single direction only.
The valves are called the aortic valve, pulmonary valve, tricuspid valve and mitral valve.
The mitral valve and tricuspid valve are located between the atria and the ventricles.
The aortic valve and pulmonary valve are located between the ventricles and the major blood vessels leaving the heart.
Types of heart valve disease
When heart valves become diseased or damaged, they may not completely open or close. Your heart will find it hard to pump properly. As a result, your heart will pump even harder to make sure there is enough blood circulating around your body. As the heart muscles become overworked, other heart problems follow.
Stenosis and regurgitation are the two types of heart valve diseases. Some people may even have a combination of both.
Stenosis occurs when your valve does not open properly. The heart becomes strained as the pressure and blood can back up.
Regurgitation, also known as an insufficiency, occurs when your valve does not close properly. Blood leaks through the valve rather than flows in one direction only. Also, the heart is forced to work harder to maintain enough blood circulating around your body.
Aortic Stenosis
What is Aortic Stenosis (AS)?
Valves in the heart act like windows to ensure blood flows from one chamber/structure to the next in a single direction.
Aortic stenosis is a disease described by the narrowing of the valve opening due to congenital abnormality, age-related degeneration and rheumatic valve disease. This will interrupt the ability of the heart to pump blood out to supply the body. Over time, the heart function will progressively weaken.
Patients with moderate to severe AS may not show any symptoms at all. However, in the late stages, patients may complain of chest pain (angina), shortness of breath (dyspnea) and even fainting spells (syncope). These symptoms are made worse with physical activity.
What are the causes of aortic stenosis?
Several conditions can cause your aortic valve to thicken. Among them are:
What are the aortic stenosis symptoms?
When you have mild aortic stenosis, you may never feel any symptoms. For serious cases, there are some symptoms worth noting. They include:
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Transcatheter Aortic Valve Implantation (TAVI)
Transcatheter Aortic Valve Implantation (TAVI), also known as Transcatheter Aortic Valve Replacement (TAVR), is a minimally invasive procedure used to treat severe aortic valve disease, particularly aortic stenosis. Unlike conventional open-heart surgery, TAVI enables the diseased valve to be replaced without the need for a large chest incision or stopping the heart.
Advances in valve technology, imaging techniques, procedural planning, and operator experience have significantly improved the safety and effectiveness of TAVI. In appropriately selected patients, outcomes are comparable to surgical aortic valve replacement, with the added benefits of reduced recovery time, shorter hospital stays, and a faster return to normal daily activities.
How does TAVI Work?
During the procedure, a biological replacement valve mounted on a specialised catheter is guided through a blood vessel, most commonly via the artery in the groin (transfemoral approach), although alternative access routes such as the shoulder artery may be used when necessary. Using real-time X-ray imaging and echocardiographic guidance, the replacement valve is carefully positioned within the diseased native valve.
Once correctly positioned, the new valve is deployed, immediately taking over the function of the diseased valve and restoring normal blood flow from the heart to the body.
TAVI may be performed under either general anaesthesia or conscious sedation, depending on the patient’s condition and procedural requirements.
Benefits of TAVI
- Minimally invasive approach with no need for open-heart surgery
- Shorter intensive care unit (ICU) and hospital stays
- Faster recovery and reduced wound-related discomfort
- Lower risk of significant bleeding compared with surgery in selected patients
- Earlier mobilisation and return to daily activities
- Improved symptoms, quality of life, and functional capacity
Complications of TAVI
While TAVI is generally safe and well established, as with any medical procedure, certain risks may occur, including:
- Stroke
- Heart rhythm or electrical conduction abnormalities that may require permanent pacemaker implantation
- Leakage around the implanted valve (paravalvular leak)
- Obstruction of the coronary arteries
- Vascular complications related to the catheter access site
- Bleeding or infection
- Kidney injury
- Death (rare, but possible in high-risk patients)
TAVI may be minimally invasive, but it is a highly specialised procedure requiring precise imaging, valve selection, access planning and implantation. Centres that perform TAVI regularly are more likely to have a well-practised multidisciplinary Heart Team, established clinical pathways and the facilities to recognise and manage complications quickly.
Large registry studies have found an association between higher institutional TAVI volumes and lower, more consistent 30-day mortality outcomes. Professional consensus guidance also emphasises that a strong TAVI programme depends not only on procedural numbers, but on experienced operators, appropriate infrastructure, multidisciplinary decision-making and continuous outcome monitoring.
Established and Experienced TAVI Program
When it comes to TAVI, experience is not limited to the doctor performing the procedure. It involves an entire Heart Team working together from patient assessment and detailed imaging to valve selection, implantation, recovery and follow-up.
At CVSKL, repeated team experience helps support:
- More accurate treatment planning and valve selection
- Better anticipation and management of complex anatomy
- Coordinated care between cardiologists, cardiac surgeons, imaging specialists, anaesthetists and nurses
- Established protocols for managing potential complications
- A smoother pathway from consultation to recovery
Since establishing the TAVI program in 2019, CVSKL has successfully performed more than 116 TAVI procedures. A steady growth of cases reflects the increasing referral confidence, expanding expertise and growing demand for minimally invasive structural heart therapies.
Advancing Structural Heart Care
Structural heart procedures require more than technical expertise alone. Successful outcomes depend on careful patient selection, advanced imaging, precise procedural planning and close collaboration between cardiologists, cardiac surgeons, vascular surgeons, imaging specialists, anaesthetists and the wider Heart Team.
At CVSKL, our Structural Heart Programme continues to evolve through growing procedural experience, regional knowledge-sharing and the ability to manage increasingly complex cases. Each milestone reflects our commitment to expanding treatment options for patients with structural heart disease while maintaining a coordinated, team-based approach to care.
Our TAVI Milestones
24 November 2021: Malaysia’s First Certified TAVI Proctor
Datuk Dr Rosli Mohd Ali became Malaysia’s first certified Transcatheter Aortic Valve Implantation (TAVI) proctor.
As a TAVI proctor, Datuk Dr Rosli is entrusted with training, supervising and evaluating doctors who are developing their experience in the procedure. Proctorship pairs clinicians who are new to TAVI, or who have performed only a limited number of cases, with an experienced specialist who can provide structured guidance throughout case selection, procedural planning and valve implantation.
This guided training is particularly important in the rapidly advancing field of interventional cardiology. It supports the safe transfer of clinical knowledge, encourages adherence to established standards and helps develop the next generation of specialists capable of advancing structural heart care.
23 June 2025: Reaching 100 TAVI Procedures
CVSKL marked the successful completion of its 100th TAVI procedure, a significant milestone in our efforts to provide suitable patients with severe aortic stenosis an alternative to conventional open-heart surgery.
At the time, this represented the highest number of TAVI procedures performed by a single private hospital in Malaysia.
The milestone reflects the programme’s steady growth since its establishment, supported by increasing patient trust, stronger regional referrals and the combined expertise of CVSKL’s multidisciplinary Heart Team.
10 April 2026: Expanding Access Through a Carotid Approach
Although TAVI is most commonly performed through the femoral artery in the groin, this route may not be suitable for every patient. Some patients have arteries that are too small, severely narrowed, heavily calcified or otherwise unsuitable for the passage of the valve delivery system.
Following comprehensive assessment, advanced imaging and multidisciplinary planning, the CVSKL team successfully performed TAVI through the patient’s left carotid artery as an alternative access route.
The carotid cutdown was performed by Dr Tan Kong Hean, Consultant Vascular and Endovascular Surgeon. The TAVI procedure was led by Consultant Cardiologists Dato’ Dr Tamil Selvan Muthusamy, Datuk Dr Rosli Mohd Ali and Dr Choo Gim Hooi, with valued support from Dr Mann Chandavimol, Senior Interventional Cardiologist from Thailand. This complex case demonstrates the importance of collaboration across specialties, meticulous procedural planning and meaningful regional clinical partnerships. It also reflects CVSKL’s continued expansion of its structural heart capabilities, enabling the team to consider alternative treatment strategies for patients with more challenging anatomy.
The Patient Experience
Behind every milestone is a patient whose life has been affected by severe aortic stenosis. In our special three-part patient story series, former TAVI patients share their experiences—from living with symptoms and considering their treatment options to undergoing the procedure and returning to everyday life.
Hear directly from our patients and discover their TAVI journeys.
Mitral Valve Regurgitation
What's mitral valve regurgitation?
Mitral regurgitation is backward blood leakage through the mitral valve each time the left ventricle contracts.
A leaking mitral valve causes blood to flow in two directions during the contraction. Some blood flows through the aortic valve (as it should normally) and some blood flows back into the atrium.
What's the problem that results from mitral regurgitation?
What are the causes of mitral valve regurgitation?
Possible causes of mitral regurgitations are:
- Mitral prolapse
- Damaged tissue cords
- Rheumatic fever
- Endocarditis
- Heart attack
- Cardiomyopathy
- Congenital heart defects
What are the mitral valve regurgitation symptoms?
Some people who have mitral valve disease may not experience any symptoms for many years. Depending on its severity and how quickly the condition progresses, signs and symptoms of mitral valve regurgitation include:
- Abnormal heart sound (heart murmur) heard through a stethoscope
- Shortness of breath (dyspnea), worsened by physical activity or when lying down
- Fatigue
- Heart palpitations — sensations of a rapid, fluttering heartbeat
- Swollen feet or ankles
MitraClip Transcatheter Mitral Valve Repair
What is MitraClip?
The MitraClip is a device delivered to the heart through a small incision made in the blood vessel in the groin area. The heart continues beating during the procedure and does not require a heart-lung bypass machine as in open heart surgery.
During the mitral valve repair procedure, a catheter (a thin, flexible plastic tube) is inserted through the patient’s skin in the groin area and is guided through the femoral vein to the affected area of the heart.
Then, a catheter that holds the MitraClip device goes in through the first catheter so that the MitraClip can be guided into place and attached to the leaflets of the mitral valve. Once the clip is properly placed and securely attached, it is deployed, and the catheters are removed.
Benefits of MitraClip
- Improved quality of life.
- Improved symptoms.
- Reduced chance of hospitalization.
- Likely reduction in heart size.
- Improvement of heart shape.
- Reduction in mitral regurgitation.
- Avoidance of high surgical risk.
Complications of MitraClip
- Stroke
- Possible multiple uses of MitraClip
- Vascular access site-related complications
Know Your Treatment Options at CVSKL
CVSKL is one of the very few Cardiovascular Centres of Excellence in Malaysia capable of performing TAVI & MitraClip procedures. Our Heart Team comprises a group of experienced and internationally renowned cardiologists, cardiothoracic surgeons, vascular surgeons, cardiac anaesthetists and cardiac imaging specialists who work cohesively and collaboratively to ensure the best outcomes for our TAVI & MitraClip patients.
Our renowned interventional cardiologist, who is an in-house TAVI proctor, has made significant contributions in the field of TAVI procedures, particularly for patients with aortic stenosis in Malaysia.
