Transcatheter Aortic Valve Replacement (TAVR)
WHAT IS TAVR?
Transcatheter Aortic Valve Replacement (TAVR) is a well-proven procedure for aortic valve replacement in people who are considered as high risk patients for Open Heart Surgery. In this procedure, a new aortic valve is fixed without removing the old, damaged valve with the help of a specialised catheter through a process similar to stenting. A new artificial valve wedges into the place of the older aortic valve. A dedicated Heart Team consisting of Interventional Cardiologist, Cardiac Surgeon, Non-Invasive Cardiologist, Cardiac Radiologist and the Cardiac Anaesthesiologist, first conduct a comprehensive evaluation to determine whether this procedure is an appropriate treatment option for the patient or not. This includes Clinical Examination, Echocardiogram, CT scan and Cardiac Catheterization.
HOW IS TAVR PERFORMED?
Somewhat similar to a stent placement in an artery, the TAVR approach delivers a fully collapsible replacement valve to the original valve site through a specialised tube-based delivery system (Catheter). It is done by a small puncture in the groin, entering through the Femoral Artery (large artery in the groin), and usually does not require any major cut. The valve is taken through the specialised delivery catheter at the site of the original valve and is deployed there. Once the new valve expands, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow. The small puncture in the groin is finally sealed.
WHAT IS AORTIC VALVE STENOSIS (AS)?
Aortic Stenosis is one of the most common and serious valve disease problems. In this, a heart valve situated at the gateway between the main pumping chamber of the heart (Left Ventricle) and the big blood vessel (Aorta), that supplies blood to the whole body, becomes thick, calcified and narrowed. The heart chamber has to work harder against the narrowed, diseased valve and ultimately starts failing. The treatment constitutes replacing the diseased aortic valve with a new valve. The common causes of this disease are old age, rheumatic infection or a structurally malformed valve present from birth, degenerating by the fourth or the fifth decade of life. They all result in calcification and scarring of the valve leading to restriction of the amount of blood flow. The treatment involves replacing the valve either by an Open Heart Surgery or through an approved non-surgical technique like Angioplasty called TAVR.
HOW DO YOU SUSPECT AORTIC STENOSIS FROM YOUR SYMPTOMS?
It's important to note that many people with Aortic Stenosis do not experience noticeable symptoms until the amount of restricted blood flow becomes significantly reduced. Symptoms of Aortic Stenosis may include breathlessness, chest pain, pressure or tightness, fainting (also called Syncope), palpitations or a feeling of heavy, pounding, and noticeable heartbeats. Also, decline in activity level or reduced ability to do normal activities requiring mild exertion. Even sudden death can occur or heart may gradually fail.
HOW IS TAVR DIFFERENT FROM THE SURGICAL TECHNIQUE OF VALVE REPLACEMENT?
It is a minimally invasive interventional (non-surgical) technique performed in a cath lab, like Angioplasty, and does not need the chest to be opened, has low hazards and risks of long hours of general anaesthesia as needed in case of Open Heart Surgery. There is no big scar and the puncture site is sealed off at the end of the procedure. It can even be performed in an awake condition under mild sedation. The hospitalisation is just three to four days and the stay in ICU is just a night for monitoring and recovery after the procedure is done. The person can return back to normal life activities soon after a discharge from the hospital. It has lower risk for the patients who have multiple serious medical or surgical conditions as discussed, that make them risky or unfit for Open Heart Surgery. A small percentage of patients similar to open heart surgical valve replacement, may require permanent pacemaker implantation.
WHO IS A GOOD CANDIDATE FOR TAVR?
At this time, the procedure is reserved for those people for whom an open heart surgical procedure is a high risk due to medical and surgical conditions like old age, previous heart surgery, severe lung disease, diabetes, kidney failure, dependent on oxygen at home, and severely calcified Aorta (Porcelain Aorta). A person whose previous artificial aortic valve is degenerated can also have a new valve through this technique without a redo open heart surgery. Although relatively new, TAVR is an effective option to treat and improve survival and quality of life in these patients. It is an established and well-proven treatment for severe Aortic Stenosis.
BEST TAVR SPECIALISTS IN INDIA
MD, DM, FACC, FESC, FSCAI, FHRS, FCSI
Director
Interventional Cardiology
Dr. Anil Dhall has done his Post- Doctoral training in Cardiology from G. B. Pant Hospital, New Delhi. He has also done Fellowship with American College of Cardiology, European Society of Cardiology, Society for Cardiovascular Angiography and Interventions, Heart Rhythm Society and Cardiological Society of India.
Past Experience
He has a vast experience of 20 years in the field of Cardiology
- Director of Cardiology at Sarvodaya Hospital & Research Center, Faridabad
- Director of Cardiology at Delhi Heart & Lung Institute.
- Director & Head of Cardiology at Artemis Health Institute, Gurgaon
- Senior Consultant and Unit Head at Max Devki Devi Heart & Vascular Institute, Saket
- Senior Adviser & Professor at Army Hospital, Indian Armed Forces (Research & Referral) Delhi Cantt.
SurgeryToursIndia.com Cares
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Also Read: Pediatric Cardiac Surgery in India
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