Know Everything About Transcatheter Aortic Valve Implantation In India

The first Transcatheter Aortic Valve Implantation In India was in done 2011 in an 80-year-old female patient 

A healthy heart beats 100,000 times a day and has four valves – the aortic valve, the pulmonic valve, the mitral valve, and the tricuspid valve. These valves supply oxygen-rich blood to the body. These valves open when the heart allows blood flow and closes in between the heartbeats to prevent the blood flow in the backward direction (backward regurgitation). 

What are valve disorders?

The heart’s functioning is disturbed when the aortic valve opening narrows causing problems in overall health. Aortic stenosis is a life-threatening condition that causes when the aortic valve opening narrows. Age, hereditary factors, cholesterol, rheumatic fever, and calcium deposits on the leaflets are some of the main reasons behind the occurrence of aortic stenosis. If left untreated, it can lead to sudden death or heart failure. 

Aortic Regurgitation is another serious health problem characterized by a damaged valve and the blood flows backward. As a result, the heart has to pump harder to circulate the blood. 

What are the observable symptoms of Aortic Stenosis?

Aortic Stenosis is a life-threatening valve disease. You may require a medical diagnosis if you experience any of the following symptoms:

• Pain in the chest
• Fatigue or tiredness
• Inability to exercise
• Light-headedness
• Heart murmurs
• Dizziness
• Breathing problems
• Swollen ankles

Evaluation & Diagnosis of Aortic Stenosis

Based on the symptoms you’re experiencing, your doctor may conduct evaluation tests that are as follows:

• Electrocardiogram: This painless test helps to detect if there are any enlarged heart chambers, heart disease, or abnormal heart rhythms.
  

• Imaging tests: Your doctor may perform a series of imaging tests such as CT scans, and X-rays to check if your heart is enlarged, the size of your aorta, calcium deposits on your aorta, and the signs of the swollen aorta, or to have a closer look at the aorta. X-rays provide a detailed view of your heart.
  

• Cardiac MRI: This test helps in determining the severity of the disease and evaluating the size of the aorta.

What are the treatment options for Aortic Stenosis?

Your doctor may delay the surgical approach and prescribe drug therapy to relieve pain symptoms from aortic stenosis for the short term but will eventually perform valve replacement. Depending on your case and overall condition, different surgical approaches opted by your doctor are:

Surgical Aortic Valve Replacement (SAVR)

– It is a traditional form of treatment approach for aortic stenosis for many years.
– Your doctor may use either the traditional method or a minimally invasive approach. However, both methods involve incisions.
– The doctor uses a heart-lung machine during the surgery to provide artificial oxygen support.
– After making incisions, the surgeon gets access to the heart valve, removes the diseased one, and implants an artificial heart valve.
– The hospital stay is for more than a week.

Trans Catheter Aortic Valve Replacement (TAVR)

– A minimally invasive surgical procedure to replace a damaged, narrowed aortic valve. This procedure is applicable when traditional surgery fails.
– The procedure takes about two hours.
– This procedure is also called transcatheter aortic valve implantation (TAVI).
– It is done in the same way as the stent is implanted.
– This procedure does not require any heart-lung machine as there is no pausing of heart activity or opening of the chest cavity.
– The surgeon makes small incisions to insert a catheter to place a new valve. Once the new valve starts expanding, it pushes the old valve leaflets and the new valve starts the task of regulating blood flow.

Who is eligible for undergoing Trans Catheter Aortic Valve Replacement (TAVR)?

Patients with severe symptomatic aortic stenosis are eligible for undergoing TAVR. Your doctor may also prefer this approach when there are higher risks involved with open surgery.TAVR is also a possibility when the previous surgery to replace the aortic valve failed and is not functioning properly. 

However, there are some factors that may prohibit you from undergoing TAVR and they are:

• Age
• Calcified aorta
• Previous heart surgery
• Any other disease related to lungs, kidneys, or liver
• Diabetes

SAVR Vs TAVR: How do they differ

TAVR overcomes the limitations of SAVR to implant a new aortic valve. Following are some points that highlight the main difference between SAVR and TAVR:

• It is a minimally invasive approach that can be conducted in a cath lab.
• No general anesthesia is required as there is no opening of the chest cavity.
• It is carried out under mild anesthesia. 
• No bigger scars post-surgery.
• A shorter hospital stay of three to four days.
• Less risky and quicker recovery.
• No post-operative side effects as such.

Preparations for your TAVI Procedure: What to do before TAVI

Before the TAVI procedure, a team of medical personnel will discuss the procedure with you and your family. In return, you may likely to clear your doubts if you have any. Also, the doctor will plan your schedule will include a diet plan, medications, or staying hydrated as per the needs of the treatment. You are likely to consider some other factors as well:

• Ingestion: Your doctor will tell you when to stop eating or drinking before the procedure.

• Allergies: Don’t forget to discuss allergies even if you have medications. This is quite important.

• Medications: If you’re on regular medication, discuss with your doctor whether you can continue or stop before the procedure.

• Additional factors: Before the TAVI procedure, it is necessary to wear off jewelry, sunglasses, contact lenses, etc.

How the TAVI Procedure works

TAVI procedure involves the repair of the valve without removing the old one. It squeezes the new valve into the old valve’s place. This is why this procedure is called either a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). The surgical procedure depends on your overall condition. The procedure begins with:

• Heart Monitoring: Your surgeon monitors your heart rate, pulse rate before beginning the procedure.

• Incisions: Now, the surgeon makes a small incision in the leg or chest to access the heart.

• Catheter Insertion: The surgeon places a new valve onto a catheter and inserts it through the incision. 

• Placing the valve: Once it reaches the heart, the new valve pushes aside the diseased valve. The new valve must function properly close and open like a normal aortic. The surgeon makes sure about the valve’s functioning before closing the incision. 
• Ejection of Catheter: After the surgeon successfully places the valve, he/she withdraws the catheter before closing the incision with sutures.

You may feel relief from pain symptoms after the TAVR is done. Sometimes, it may take a little longer. Discuss with your doctor how long it takes to recover.

Precautions and Recovery after TAVR

Depending on your recovery and overall health, your surgeon may discharge you two to three days after the procedure. Although precautions still need to be taken such as:

• If you notice any of the symptoms like cough, swollen legs, congestion, pain in your chest, breathlessness, or palpitations, consult your doctor immediately with no delay.
• The procedure site is prone to infections. It should be maintained hygienically. Keep the procedure site dry for at least two weeks.
• Also, refrain from the procedure site from applying lotions or ointments.
• Blood-thinning medications to prevent the formation of blood clots.
• Do not leave the dressing at the site of the incision for more than 24 hours.
• There are higher chances of infection post-surgery. Therefore, take medicines as prescribed. 

Why Transcatheter Aortic Valve Implantation in India

India is one of the leading healthcare providers in the world because of its highly experienced medical personnel, well-equipped infrastructure, reduced treatment costs, availability of the latest medical resources, and healthcare services meeting international standards with better survival rates and outcomes.