Heart valve replacement without open surgery and an introduction to 'Heart Team' approach

March 25, 2017, Chennai

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Chennai, March 25 : Transcatheter Aortic Valve replacement (TAVR)  has come as a boon and best alternative for patients with severe aortic stenosis. The problem with stenosis is that old age, a history of bypass surgeries or other health factors like lung or kidney disease, often make it impossible to carry out open surgeries.

The most common treatment available for aortic stenosis is open heart surgery. In the last few years, Transcatheter Aortic Valve Replacement (TAVR) has generated excitement as a promising alternative for high risk aortic stenosis patients. 

Dr AB Gopalamurugan , India’s leading Interventional Cardiologist, SIMS Hospitals Chennai said “Patients with severe aortic stenosis often develop symptoms that can restrict normal day to day activities such as walking short distances and climbing stairs. These patients can often benefit by replacing their ailing valve but only approximately around two-thirds of the patients undergo procedure every year across the globe. The reason is lack of awareness and delayed treatment. Once symptoms appear, untreated patients have a poor prognosis. Without treatment, symptomatic severe aortic stenosis will eventually lead to death.”

Dr Praveen Chandra, Medanta hospital, Gurgaon further said “Until recently, a diseased valve could only be replaced by putting a patient on a heart-lung bypass machine, cutting open the chest and then stitching up the new valve inside the heart. The trauma of such major surgical procedures has now become a thing of the past. Now with the availability of latest cutting-edge TAVR (transcatheter heart valve replacement) technology, we are able to extend lives for all the elderly patients. 

Dr Prashanth Vaijyanath, Director of Cardiac surgery, KMC, Coimbatore said “A very important feature of this TAVR procedure is that it has shown not only to improve the length of peoples' lives but also the quality of life. TAVR is a great addition to our ability to care for patients with valvular heart disease, and for the appropriate patient, we've seen outstanding results”.

“Patients who undergo a minimally invasive TAVR procedure may experience faster recovery and, often, a shorter hospital stay (3-5 days on average) than patients undergoing open heart surgery. TAVR is the first-line therapy for inoperable and high risk patients with severe aortic stenosis. We are happy to have access to the latest advancements in medical technology and are able to offer world class therapies to our patients,” said  Dr AB Gopalamurugan

TAVR System replaces a diseased aortic heart valve through a minimally invasive procedure, without open-heart surgery and without surgical removal of the diseased valve. The device is typically inserted via an artery in the leg and then guided through the arteries into the heart. Once in place, the device expands and takes over the original valve’s function to enable oxygen-rich blood to flow efficiently out of the heart. 

Dr AB Gopalamurugan explained about all three cases who are doing very well on follow up and presented three complex and different case studies who had undergone TAVR procedure. 

Explaining on the first case study Dr AB Gopalamurugan said “Recently, about 3months ago I operated on an elderly old severe aortic stenosis patient Mr. M and I am extremely happy to see him doing very well  He is a known case of diabetes, high blood pressure and coronary artery disease patient who had undergone bypass surgery in 2001. He also had chronic kidney disease and chronic obstructive airway disease. He had recurrent admissions for heart failure due to severe aortic stenosis. He underwent successful treatment using the TAVR procedure and now doing well.” 

Explaining on the second case, Dr AB Gopalamurugan said “Mr. AVP, gentleman with Liver failure presented to us with complaints of exertional dyspnea for last 6 months with highly challenging anatomy. On evaluation he was found to have severe calcific aortic stenosis and was operated successfully using the TAVR. The third case presented was of Mr KM, a elderly gentlemen was admitted with history of breathlessness for 10 days elsewhere. He collapsed and was intubated and on mechanical ventilator (artificial breathing). She was diagnosed to have severe aortic stenosis. She was stabilized and treated with TAVR procedure using local anesthesia”.

Dr Gopalamurugan summarized that all the patients underwent TAVR by using a truly percutaneous method and were fully awake immediately after the procedure and were mobilized the next day. All are followed up and have remarkable improvement in symptoms’. 

The disease of Aortic Stenosis in Indian population affects close to one million elders every year. Fifty per cent of patients suffering from Aortic Stenosis can face death, if not treated on time.  

But mostly people are still unaware that the Aortic Stenosis (AS) is a crippling disease that affects the elderly. AS is the most common valvular heart disease and the third most common cardiovascular disease after hypertension and coronary artery disease in the western world. 

Aortic Stenosis is a very common valvular heart disease and it can lead to significant mortality and morbidity in the elderly population. The prevalence of AS increases from, 2% in adults over 65 years of age to 4% in adults over 85 years of age. AS is a progressive condition and after the onset of heart failure, survival is less than 2 years without valve replacement. 50% of patients with AS presenting with angina, syncope or heart failure, survive for 5, 3 or 2 years respectively without aortic valve replacement (AVR). 

Although relatively new, TAVR can be an effective option to improve quality of life and survival in high risk patients who otherwise have limited choices.