Aortic Stenosis & treatment with tavr
Narrowing of the aortic valve in the large blood vessel branching off the heart (aorta). The narrowing keeps the valve from opening fully, reducing blood flow to the body and making the heart work harder. The heart may weaken, causing chest pain, fatigue, and shortness of breath. With no intervention at the right time, this can cause a fatal outcome.
Until a few years ago, for treatment of severe aortic stenosis, Valve replacement via Open heart surgery was the only option. As per evidence, about 40 percent of the population cannot undergo surgery due to the extreme or high risk for surgery.
In these patients, a new modality called the Transcatheter Aortic Valve Replacement (TAVR) has become the choice of treatment. TAVR is a less invasive procedure. This procedure uses a catheter to implant a new valve within the diseased aortic valve. A properly trained and dedicated multidisciplinary heart team at the center is involved in conducting a thorough evaluation to determine TAVR as a treatment option.
Doctor Interview Video: Dr. Rajneesh Kapoor, Vice Chairman- Interventional Cardiology at Medanta The Medicity Gurugram, explains about functions, types & diseases of heart valves.
The first symptom could be breathlessness, whether it is narrowing, whether it is to stenosis, whether it is leakage, and initially breathing discomfort happens on exertion only, but slowly as the disease advanced - as there is more strain on the heart- the breathlessness starts to happen at rest also, and especially on lying down.
"Normally the opening of the aortic valve is four to six centimeters square, but if it goes less than one cm square, I think that is one point where we can't ignore it, because the patient becomes at very high risk of sudden cardiac death and heart failure" says Dr. Rajneesh Kapoor from Medanta Hospital
The whole procedure (TAVR) is done through access in the artery, which is usually taken from the groin, no surgery, no cut on the chest, no incision done no blood loss. It has to be done with proper expertise and proper steps
transcatheter aortic valve replacement, a technology-based alternative to surgical aortic valve replacement, performed by an expert interventional cardiologist is fast growing in India as a first-line treatment option, especially in elderly patients. Most of the frequently asked questions on tavr are answered by Dr. Rajneesh Kapoor - the best tavr expert in India.
These unique cases were performed successfully by Dr. Rajneesh Kapoor, Dr. Himashu Dabral & other team members
As the TAVR / TAVI procedure is less invasive, you may be able to return to routine activity more quickly than open heart surgery. Patients who have undergone a TAVR / TAVI procedure report an improvement in their quality of life soon after. Other advantages of TAVR / TAVI include a shorter stay at the hospital, no chest scars, immediate relief of symptoms, improvement of heart function, and decreased pain and anxiety.
The life of your TAVR / TAVI valve depends on numerous factors and differs for each person. However, its functioning can be checked from time to time through regular follow-up with your doctor.
No, the valve will not be felt after placement.
First prerequisite is - patients should have critical aortic stenosis. The narrowing of the aortic valve should be critical. And as I mentioned, to give you a parameter one centimeter square of aortic valve area or less. So these are the candidates and which TAVR should be considered. The patient should be symptomatic like breathing discomfort or syncope episode, loss of consciousness or chest discomfort or a heart function is going down because of the dysfunction. So these are the subset of patients who require the aortic valve treatment.
Now we do the further ramification whether they are fit for surgical aortic valve replacement. We need to ascertain that fact. If the patient is beyond sixty-five years of age, the heart is frail, then the patient becomes a very high-risk candidate for surgical aortic valve replacement. And those are the patients where we're clear, as a guideline, that tavr is indicated and preferred over surgical AVR.
There are other factors also where they become very high risk for surgical aortic valve replacement- Like any comorbidities, the patient has a lung problem, the patient may have a liver issue or other comorbidities, the patient may have a heart dysfunction of severe gravity that itself is a high-risk factor for surgery. So all these subsets are clear indicators for tavr to be considered over and above the surgical aortic valve replacement.
