TAVI/ TAVR for Indian patients - a boon for elderly (at Bangalore)

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure for the treatment of a severe narrowing of the aortic valve in the heart. It involves the placement of a new artificial valve inside the diseased valve, without the need for open-heart surgery. This procedure has emerged as a game-changer for those with advanced age, frail health, or multiple comorbidities.

India has one of the largest populations of patients with aortic stenosis, and the incidence increases with age. Aortic stenosis is the narrowing of the aortic valve, which reduces the blood flow from the heart to the rest of the body. The symptoms include shortness of breath, chest pain, dizziness, fainting, and fatigue. With the increasing life expectancy, the prevalence of aortic stenosis is expected to rise dramatically over the next few years.

Traditional surgical aortic valve replacement (SAVR) is the gold standard treatment for severe aortic stenosis. However, not all patients are candidates for SAVR, especially the elderly and those with multiple co-morbidities. TAVR is an alternative option for such patients, who are considered to have a high or intermediate surgical risk, and for whom SAVR is not feasible.

TAVR involves making a small incision in the groin or chest, through which a catheter is inserted into the artery, leading to the heart. A balloon is inflated to widen the diseased valve, and then a new artificial valve is implanted via the same catheter. The whole procedure typically takes about 2-3 hours, and the patient can return home within a few days.

TAVR has several advantages over SAVR, including reduced mortality and morbidity rates, faster recovery times, shorter hospital stays, and fewer complications. Also, TAVR is less invasive and involves less trauma, which is especially beneficial for elderly and frail patients.

At Fortis Hospital, Bangalore, Dr. Srinivasa Prasad heads a dedicated team of experienced structural heart specialists who are well-equipped to perform TAVR in patients with severe aortic stenosis. We use state-of-the-art technology and advanced imaging techniques to ensure the success of the procedure. Our goal is to provide safe and effective treatment to all our patients, with the aim of improving their quality of life. Currently team is running a special drive for TAVR at discounted price for the select few needy patients (for year 2023)

In conclusion, TAVR is an innovative and effective treatment for severe aortic stenosis, especially for elderly and high-risk patients who are not fit for traditional surgery. If you or your loved one is suffering from aortic stenosis, consult with your healthcare provider to determine if TAVR is a suitable option for you. Remember, a healthy heart is crucial for a healthy life!

Mitraclip - a clip to reduce the valve leakage of mitral valve

As artificial intelligence and machine learning drive innovation in the medical field, a new revolution is brewing in the form of minimally invasive surgical procedures. One such procedure is MitraClip, an FDA-approved device that aims to treat a common heart condition known as mitral regurgitation.

Mitral regurgitation occurs when the mitral valve, which separates the left atrium and the left ventricle, does not close properly, leading to blood leaking back into the left atrium. Over time, this can result in an enlarged heart and heart failure. Traditionally, surgery to repair or replace the mitral valve has been done through open-heart surgery, which is a major procedure with a significant recovery time. However, MitraClip offers a less invasive option, with potential benefits including a shorter hospital stay, quicker recovery time, and decreased risk of complications as

sociated with open-heart surgery.

So, how does MitraClip work? During the procedure, a small incision is made in the groin and a catheter is inserted through a vein to the heart. The MitraClip device is then guided to the mitral valve and clipped onto the valve to improve its function. The procedure can be performed under conscious sedation or general anesthesia and typically takes a few hours.

The benefits of MitraClip are not just limited to the patient experience. The device also offers potential cost savings for healthcare systems. One study found that the procedure reduced the rate of hospital readmissions and was cost-effective compared to traditional surgery over a five-year period.

MitraClip has been tested in clinical trials and has shown promising results. In the COAPT trial, patients with moderate to severe mitral regurgitation who were treated with MitraClip had a lower rate of hospitalizations and deaths compared to those who received medical therapy alone.

However, MitraClip is not suitable for all cases of mitral regurgitation. Patients must undergo a thorough evaluation to determine if they are a good candidate for the procedure.

In conclusion, MitraClip is a minimally invasive option for treating mitral regurgitation that offers potential benefits for patients and healthcare systems. As technological advancements continue to drive innovation in the medical field, more procedures like MitraClip may be developed to provide improved outcomes for patients.

TAVI (Transcatheter Aortic Valve Implantation)

1. Transcatheter Aortic Valve Implantation (TAVI)

The treatment of choice for severe aortic stenosis in elderly is now transcatheter aortic valvular implantation. This procedure involves implanting a balloon expandable stent inside the diseased aortic valve.

2. Preoperative Assessment

To determine whether this procedure is suitable for a particular patient, a multidisciplinary team of cardiologists and cardiac surgeons, Anesthetists assesses the individual's medical history, physical examination, laboratory results, imaging studies, and any previous surgical procedures. More critical part of assessment is CT aortogram

3. TAVI Procedure

Once the decision to proceed with TAVI is made, patients are taken into cathlab, where the procedure is done under conscious sedation or local anesthesia. (There is no need for general anesthesia or endotracheal intubation). Femoral artery is punctured, a small sheath is placed. Next, a guide wire is advanced through the femoral artery into the left ventricle. Finally, the balloon-expandable valve is introduced through the femoral artery and positioned at the level of the aortic annular ring and valve is deployed by inflating the balloon. once deployed, balloon is deflated and taken out. Femoral sheath removed and puncture site is closed using closure device

4. Postoperative Care

After the procedure, patients are monitored closely in the intensive care unit for few hours. Blood pressure, pulse oximetry, electrocardiography, and temperature are measured every few minutes. Patients typically are made to ambulate within 6-8 hours, remain in hospitalized overnight and are usually able to return home within one to two days after the procedure.