Transcatheter Aortic Valve Replacement or Implantation (TAVR or TAVI)

Transcatheter Aortic Valve Implantation

Posted on : 29 Jul 2019

Over the last few decades, the life expectancy of an average Indian has increased. With increasing longevity, health problems of advanced age also tend to grow in the communities. One such issue is the degeneration of heart valves in the elderly.

 Aortic stenosis or narrowing of the aortic valve, one of the four valves of the human heart can be due to several reasons and is seen at any age. But the most prevalent form of Aortic stenosis is due to the age-related wear & tear and therefore seen in men and women in their advanced age. AS in the elderly leads to severe disability and if symptomatic AS is untreated, lead to the mortality of the patient.

The only effective treatment of valvular AS in adults is replacement of the diseased aortic valve with an artificial valve. It entails open-heart surgery, stopping the heart for a few hours to remove the diseased valve and suture an artificial one. The challenge in the elderly patients, especially those who have multiple other medical co-morbidities such as diabetes, lung disease, strokes and general debility is that they may not be fit enough to undergo such daunting surgery.

During the last decade, non-surgical replacement of the aortic valve by a procedure called ‘Transcatheter Aortic Valve Replacement or Implantation (TAVR or TAVI)’ has turned into a boon for these patients. The Heart Valve Replacement Surgery in JP Nagar, Bangalore can be done without operating on the chest or utilizing open-heart surgery. Here, the artificial valve is inserted into the heart through a catheter placed in the arteries of the patient’s groin. The valve is then positioned at the site of the native valve and expanded. The whole procedure can be done under local anaesthesia, without the need for general anaesthesia. The risk of the procedure is far less than the Surgical Aortic Valve Replacement (SAVR) and is increasingly becoming popular in patients who are reluctant to have open-heart surgery.

At Aster-RV hospital, JP Nagar, we have two patients with aortic stenosis and who were deemed to have a very high risk for open-heart surgery underwent the TAVI procedure. As one of the best heart hospital in JP Nagar, Bangalore, we have the experienced Aortic Valve Replacement Doctors In Bangalore who perform the surgery.  

The first patient is 82 years old gentleman Mr V Hariharan, who had undergone Coronary bypass surgery (CABG) about 20 years ago. He had developed a severe block of one of the arteries of the heart in addition to the severe narrowing of the aortic valve. He had developed severe angina, which prevented him from walking a few hundred meters without severe chest pain. Because of his older age and multiple issues in the heart, second open-heart surgery was considered as high-risk by the cardiac surgeons and the family was looking for a less invasive remedy for the debilitating symptoms the patient was suffering from. 

The second patient, 83-year-old Mr Kumaraswamy had undergone a coronary bypass artery disease for which he had undergone Coronary artery bypass (CABG) and a replacement of the aortic valve with a surgical AVR in 2006. The previously implanted artificial valve had degenerated due to wear-and-tear and had started to leak severely as well as started to obstruct forward blood flow. With this, the patient had a severe limitation of going through day-to-day activity, including walking a few yards without getting breathless and tired. Again, cardiac surgeons believed that a second open heart surgery carried a prohibitively high risk to the life of the patient and therefore, the patient explored the possibility of the less invasive TAVI procedure. 

On 3rd July 2019, both these patients underwent the procedure TAVI (transcatheter Aortic Valve Implantation) in Bangalore. While fundamentally they underwent similar procedures, there were different complexities in either’s actual operation. Mr Hariharan had to undergo a concomitant Rotablator-drill assisted angioplasty with implantation of a coronary stent to the blocked coronary artery along with the TAVI procedure. Mr Kumaraswamy’s procedure was unique because a new artificial valve was implanted through TAVI procedure into a pre-existing degenerated artificial bioprosthetic valve (Valve-in-valve TAVI). 

Both these operations performed at Aster-RV Hospital Bangalore, i.e., simultaneous coronary Rota-Stenting with TAVI procedure and Valve-in-valve TAVI procedure with the Medtronic Evolut-R bioprosthetic valves were performed for the first time in Karnataka state.  Both procedures underwent the procedures under local anaesthesia and were conscious throughout the operation. They recovered quickly and were able to walk the very next day and were discharged after 48 hours after the TAVI procedures with tremendous relief in their disabling symptoms.

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