Asian Institute of Medical Sciences serves patients with the best possible treatment through our centers of excellence. Asian Heart Center uses cutting edge technology like transcatheter aortic valve replacement (TAVR) to ensure that prohibitively at risk patients with severe aortic stenosis get the cardiac care they need. TAVR is a minimally invasive procedure to replace a narrowed aortic valve with a new one through a thin wire/catheter. The new valve starts functioning immediately upon implantation. This procedure is helpful for patients who can’t undergo surgery (like elderly) or face a high risk of surgical complications, such as diabetic patients.
What Does the Aortic Valve Do?
Oxygen rich blood passes from the heart to the rest of the body from the left ventricle of the heart to the aorta. The valve which regulates this flow of blood is called the aortic valve. However, the valve should close between heart beats. Typically, this valve should have three flaps called cusps. However, some people have a congenital defect which leads to their having only one or two cusps. This defect combined with dietary factors causing fatty deposits, adverse effects of rheumatic fever, calcification of the valves, and aging could cause a medical condition called aortic stenosis (AS) by obstructing the outflow of blood. The patient might suffer from breathlessness, chest pain, bouts of fainting, even cardiac failure, if AS is not treated appropriately. It could lead to backflow of blood from the aorta to the left ventricle, called aortic regurgitation.
Options to Treat AS
Earlier, the only options available to treat AS were either open heart surgery, balloon valvuloplasty, or being put on diuretics. TAVR, also called percutaneous heart valve replacement, has revolutionized treatment of AS completely. The new valve may be artificial, made of tissue taken from the patient’s body, or constructed out of bovine pericardial tissue.
Preparations Before TAVR
Your cardiologist will take several measures before carrying out the procedure. These include computed tomography angiography (CTA) to determine the size of the valve by getting an image of the chest, pelvis, and abdomen, besides checking whether there are any blockages in the arteries; and left heart catheterization to rule out co-morbidities like coronary artery disease (CAD) as well as identify whether there is need for revascularization.
A Multispecialty Team Carries Out the Procedure
A multispecialty team consisting of thoracic surgeon, vascular surgeon, cardiac electrophysiologist, echocardiographic imaging specialist, cardiac anesthesiologist, and highly skilled nurses will be present in the OT when the procedure is carried out. A neurologist and a nephrologist would need to be on call to deal with any complications arising during, or immediately after the procedure.
Advantages of TAVR Over Open Heart Surgery
Extend the quality and length of the patient’s life by opting for TAVR to treat AS. The biggest advantage of TAVR over open heart surgery is that a defective valve can be replaced without stopping the heart and putting it on a heart lung machine. In certain cases, the doctor might make an incision in the chest. In others, a catheter is inserted by making an incision in the groin, thrust through the femoral artery, and guided to the heart using direct visualization with fluoroscopy. A compressed valve is inserted through another balloon catheter to be placed over the damaged valve. The surgeon might use transesophageal echocardiogram (TEE) guidance to ensure that the replacement valve is placed accurately before withdrawing the catheters.
Complications: Lower rates of bleeding and kidney injury after TAVR make it a preferable option. In some patients, especially those with multiple co-morbidities, complications like acute myocardial infarction, stroke, left ventricular perforation, conduction disturbances, and infection cannot be ruled out. It usually takes about an hour and a half to mount a new valve.
Return to Normal Activities Faster
Five to seven days’ stay in hospital after the procedure, and post procedural care at home should enable the patient to gradually resume normal activities within a few days. However, regular follow up with the cardiologist is vital.