Doctors like me have been putting an effort to treat structural heart diseases without open surgery. In fact, fifteen years ago we were not even able to even conceive the idea of replacing a valve without open heart surgery. However, today it is actually possible. Here I must mention again that we are one of the first few centres to start this procedure in India and now an established centre of excellence.
Transcatheter Aortic Valve Replacement (TAVR) is performed in order to treat a patient suffering from a heart valve condition called Aortic Stenosis which is narrowing of the aortic valve. The heart has four valves and their function is to regulate blood flow from one chamber of the heart to the other to facilitate oxygenation of the blood.The left side possesses the Aortic Valve which is the major valve that separates the chamber to the Aorta – the main artery that distributes the blood from the heart to the rest of the body.
The Aortic Valve goes through a lot of wear and tear over a long period of time as the person ages, finally turning thick and narrow. Most importantly, there is a good amount of calcium deposits on the valve as well. This causes the valve to become rigid, thus constricting its capability to open and close efficiently. This condition is known as the Aortic stenosis.
Moreover, Aortic Stenosis generally happens due to aging. However, in frequently there are people who are born with this condition. The moment the stenosis becomes severe and the patient has symptoms,outcomes are worse.
Some of the major symptoms are breathlessness, chest pain (angina),a patient goes through general fatigue or tiredness while performing routine and light work. Symptoms may also include palpitations of the heart, heart murmur and fainting. The most difficult scenario is that the Aortic Stenosis may not always be “visible,” and thus a patient can have severe valve narrowing without any symptoms. The moment symptoms of Aortic Stenosis are noticed, there could be probability for the condition to quickly deteriorate.In these situations, sudden death is a major possibility without a doctor’s precise early diagnosis and treatment.
I and my team have performed the first TAVR procedure in 2015 by using the first generation core-valve. The condition of the patient was very serious and he did not have other treatment options. We faced a lot of difficulty as the valve was not available and approved in India at that time.We had to get a special license to import it.
I had treated a 69-year-old retired maths professor who had a long history of COPD. During January 2013, he was diagnosed with a heart condition known as Aortic Stenosis, a narrowing of the heart valve which caused severe breathlessness and fatigue. Patients diagnosed with severe Aortic Stenosis had a life expectancy of only 2 to 5 years.
The remedy was to get the Aortic valve replaced. He went to a reputed heart surgeon who refused to treat him because of the COPD conditions he had.
He had to be on medical treatment since he did not have any other options available. His condition was worsening year after year. His condition was so bad that even at his home he had to be put on Oxygen for all the 24 hours. While in the hospital he was admitted in the CCU repeatedly. He had completely lost hope on any chance of survival. That is when his family doctor Dr (Major) Parthasarathy advised him to consult me.
I assessed his health condition and explained him that TAVR is the only option available for him and it will definitely improve the quality of his life. Again after conducting several tests he was informed that his anatomy had a high risk factor even for TAVR, which worried him more. Due to the high risk, several other doctors advised him against TAVR.
He had less than half mind to go for the procedure initially. It was very costly and the risk was very high. He had very limited resources. It was an unbearably huge financial burden on him. I and my team of doctors explained the procedure and its pros and cons to his family members and relatives. It was also felt that if he don’t undergo the procedure, the suffering and repeated hospitalization will continue till the end affecting the daily lives.
The TAVR procedure was done on 11th February 2017. He went through the procedure under general anaesthesia without any problem. There was no pain or any significant discomfort. He felt much better immediately after the procedure. The incessant cough and discomfort disappeared. The recovery was miraculous. Within five days he was discharged from the hospital.
(Watch this for more)
I have worked with my team since 2015,and have performed the TAVR procedure using numerous new generation transcatheter heart valves, for about 25 patients. Most significantly, these patients were mostly of advanced age and have been refused surgery at other hospitals because of other problems like diabetes or kidney failure. I must mention thatconventional treatment for valve replacement is an open-heart procedure. For patients who are at high riskfor open surgery, such as patients who areweak and old, with multiple other co-morbid conditions, they were left without treatment till recently.
Columbia University Medical Centre, USA and the Presbyterian Hospital in New York, USA (and other companionassociations) have researched over 350 patients with aortic stenosis. All these patients wereapparently standing at a high risk platform for surgical valve replacement . The research was done in order to look into the causes of repeat hospitalisations, other severe complications, or death (if any) of these patients. The study delivered that of those who went through the TAVR process, rate of death was 30%, compared to 50% for those on whom regular/non-TAVR procedures were administered. The research stated that among survivors at 1 year, the degree of cardiac symptoms have gone down more among patients who had undergone TAVR than among those who had received standard therapy (25.2% vs. 58.0%).The Cardiovascular Research Foundation conducted another study which pointed out that after the end of five years patients with TAVR have lower repeat hospitalisations, and a longer and more durable life experience than the ones with standard valve replacement surgeries I have found the same with my patients as well. The 25 patients for whom I administered TAVR at Apollo hospitals, Chennai, have been living a completely healthier life without heart ailments, and look forward to a better life now. One of my patients, a 90-year-old man who was bedbound and incapable to move before TAVR, is now capable enough to walk into the clinic without any aid. He recently called me for his 91st birthday celebration.
Below given link is, Mr Sambandam 91-year-old man sharing his experience after TAVR.