Transcatheter aortic valve replacement is a boon for heart patients who need aortic valve replacement but are unfit for surgery. Dr. Rajneesh Kapoor, who works as Vice Chairman- Interventional Cardiology at Medanta The Medicity, Gurugram and is awarded as one of the best operators for TAVR in India, informs on the TAVR procedure and heart valve disease.
What are the treatment options for Heart Valve replacement?
Normally, the treatment is surgical aortic valve replacement, but at times, if the patient is not fully suitable for surgical aortic valve replacement, then a newer therapy called TAVR can be used, it means percutaneously aortic valve replacement.
What happens in TAVR?
In the treatment procedure, we need to take access, which in most cases is taken from the groin (the access is taken as we do the angioplasty or angiography). The access is taken to the femoral artery in the groin and rest we do all the maneuvers through the femoral artery. We take hardware, which is a metallic rim containing a bioprosthetic valve, inside from the femoral artery & goes into the aortic arch. And then across the diseased aortic valve, we place this metal frame, then open it to crush the diseased aortic valve. This rim contains the newer valve & as soon as we open this valve, the newer valve starts functioning and the patient gets immediate relief of symptoms and the heart gets strengthened.
What is the success rate of treatment through TAVR?
So in patients where we have done at our institute (Medanta Hospital Gurugram), the success rate is it's close to 98%. In fact, we were able to deploy the valves in all patients.
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What are the main functions of Heart Valves?
There are four valves in the heart, two on the right side in chambers and two on the left side. The main function of heart valves is to lead the blood flow in a proper direction.
What happens in heart valve disease?
Either they become stenotic where their orifice becomes narrow, or there is sound leakage across the valve. If the heart valve is stenotic, the previous chamber will be a huge strain. If there is a huge amount of leakage in the heart, well, that leads to a volume expansion in the heart leading to huge dilatations.
What are the symptoms of heart valve disease?
It presents with a lot of symptoms, in the form of breathing distress. The lungs getting flooded with a lot of fluid, the patient is not able to lie down flat 9which is called orthopnea), fatigability, exercise incapacity. All these can be features of heart valve disease.
What are the risk factors of heart valve disease?
Age is a risk factor for aortic stenosis (that is narrowing of the aortic valve) which is very dangerous. Other risk factors could be an infection on the valve and damage to the heart. The calcific deposits on other valves like the mitral valve also can damage the heart. And in the Indian scenario, the very big risk factor is rheumatic heart disease, which is an infection in childhood where the antibodies cross-react with the heart valves and lead to narrowing or leaking in the heart.
When is TAVR recommended?
So in the subset where the risk factor for surgery is high, the newer modality has come up, which is called TAVR. This is absolutely a non-surgical method of replacing the aortic valve..
How does TAVR improve the health condition of the patient?
Well, the results are so gratifying for a patient that immediately after the deployment of this newer valve through this route, the patient starts improving on hemodynamics. There is a symptom relief to a patient because the diseased aortic valve is gone and in its place a newer Valve has started functioning immediately. So this is a highly gratifying procedure for a patient, no surgery, no blood loss. the patient is even not anesthetized.
How much time does the procedure take?
This is done under small sedation and it's a one-two-hour procedure. And after the procedure, the patient is awake again. So and next day, usually patients are mobilized and the usual length of stay in the hospital is two to three days.
Expert inputs by Dr. Rajneesh Kapoor, Punjab Rattan Honorary & working as Vice-chairman- Interventional cardiology at Medanta The Medicity, Gurugram, India
