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STENTS/TAVR/TAVI

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As we all know that our heart is the center of the circulatory system. It is a network of vessels that delivers blood to every part of the body. To tell you more about how our heart functions, let us know more about the four valves that make the whole functioning possible. The heart has four valves – mitral valve, tricuspid valve, pulmonic valve, and aortic valve. 

The mitral valve and tricuspid valve are located between the upper heart chambers and lower heart chambers and amidst the ventricles and the major blood vessels, located are the aortic valve and pulmonic valve.

FUNCTIONS OF THE VALVES

These valves have different roles that keep the heart functioning properly. Hence, it should be healthy and functioning. It must be open all the so that blood can pass and valves must close tightly so no blood flows into another chamber. 

When we talk about the aortic valve, it separates the left ventricle from the aorta, allows blood to leave the heart from the left ventricle through the aorta and the body, and prevents the backflow of blood from the aorta to the left ventricle. 

When the aortic valve isn’t working properly, it becomes difficult for the heart to send blood to the rest of the body which leads to various aortic valve diseases.

AORTIC VALVE DISEASE

There are two major types of aortic valve diseases:

Aortic Stenosis

Aortic Stenosis is the narrowing of the Aortic valve opening. The narrowing of the valve could lead to reduction or blockage of the blood flow from the heart into the main artery to the body and towards the rest of the body. This forces the heart to work harder.

Aortic Regurgitation

Aortic regurgitation or insufficiency causes when the valve doesn’t close properly causing the blood to leak into the heart which over time makes the heart stretch and enlarge which later can lead to heart failure.

AORTIC VALVE TREATMENT

Treating the dysfunction of the aortic valve depends upon the severity of the aortic disease. Traditionally, Aortic Valve Replacement Surgery was done through traditional open-heart surgery. This procedure involves a cut in the chest which is risky and requires a longer recovery time. Another way is replacing a valve via a minimally invasive method where an incision is made in the chest or a catheter inserted in the leg or chest. It is by far the safest option and this procedure is called TAVR or Transcatheter Aortic Valve Replacement. 

This can be done using a mechanical valve or a biological valve. 

WHAT IS A BIOLOGICAL VALVE?

While performing the TAVR procedure, the doctor removes the damaged valve and replaces it with a mechanical valve or biological valve. Biological valves are also known as bioprosthetic valves. That is a valve that is made an animal tissue or human heart tissue. Animal tissue is known as Xenograft and human heart tissue is known as Homograft. Animal tissues are made from a cow or pig. But, to perform this procedure, depends on the severity of the condition and the situation of the patient. Accordingly, if needed, the doctor might suggest replacing the damaged aortic valve with a biological valve. 

The reason why the biological valve is used is that they degenerate over some time and they comparatively require no blood-thinning medicines, post-surgical care, and hospital stay.

Biological valves are not as strong as mechanical valves and they need to be replaced every 10 years or so. These valves breakdown much faster in children and young adults, so these valves are used mostly in elders.

WHAT IS A MECHANICAL VALVE?

Titanium and carbon are the materials used to make Mechanical valves. These valves are sewn in the place of original valves, they consist of two leaflets and a metal ring surrounded by a ring of knitted fabric. The advantage of these valves is that they are durable and last longer. But the valves provide a surface on which it is easy to form a blood clot.

These valves should be avoided for women of child-bearing age and those with a high risk of falls or bleeding.

HOW IS TAVR PROCEDURE PERFORMED USING A BIOLOGICAL VALVE?

TAVR procedure is a minimally invasive procedure that is used to repair or replace the damaged aortic valve. On the day of surgery, the doctor will decide which type of anesthesia is best for you but your heart will continue to beat during the procedure. Once you are asleep, a short hollow tube called a sheath is inserted into your femoral artery. The new valve is placed in the delivery system using a balloon at the end of the catheter. It contains the replacement valve folded around it. This delivery system is pushed up to your aortic valve. 

Once it reaches the diseased valve, it is inflated which pushes aside the leaflets of your diseased valve. This valve replacement surgery usually does not require cardiopulmonary bypass. Once the biological valve is placed, the balloon is deflated and the catheter is removed. 

The doctor will check if the new valve is opening and closing like the normal aortic valve should and close the incision once the new biological valve starts functioning properly. 

PROS OF USING A BIOLOGICAL VALVE DURING TAVR

The benefits of replacing the damaged Aortic Valve with A Biological Valve is that they don’t come with a higher risk of a blood clot. They are the best for people over the age of 65, pregnant women, and people who have kidney stones.

Valves used from Bovine (cow) is not an actual valve but it is a tissue surrounding the cow’s heart. It is strong and flexible. 

Using a biological valve during TAVR operation for pregnant women is more beneficial because it doesn’t require using blood thinners as consuming those medicines can harm the fetus. 

CONS OF USING A BIOLOGICAL VALVE DURING TAVR

TAVR, of course, includes some risks. Generally, risks are minimal which includes complications in blood vessels, infection – if not taken care of it properly, etc. Only in extreme cases, does one suffer from stroke if post-surgical care is not taken properly. It all depends on one’s health and medical history. So, if you or somebody you know is suffering from post-surgical complications, it is better to consult a doctor immediately.

To conclude, it is important to understand the risk and advantages of valve replacement surgeries. It is better to listen to the advice of your doctor and research about TAVR in depth before undergoing the procedure. TAVR is a procedure of the heart, all the precautions must be taken into consideration. And after the TAVR procedure, you should constantly be in touch with your doctor for regular health check-ups.

When it comes to treating heart health, one has to weigh the pros and cons meticulously because it’s the matter of one’s life. Each of these treatments has its outcomes. One such treatment is TAVR. With technological advancements in the field of science and medicine, these treatments have evolved and surpassed the age-old Open Heart Valve Surgery in India and made the medical process much easier. Let’s know more about TAVR and Open Heart Valve Surgery in detail.

TAVR stands for Transcatheter Aortic Valve Replacement which is a newer and minimally invasive option to treat aortic valve disease. It is effective for people who cannot undergo surgery to replace the narrow valves. Many top medical experts from the top TAVR hospitals in
India says that it is a non-surgical life-saving option. It is similar to angioplasty and is done in the Cardiac Catheterization Lab (Cath-lab).

Earlier, the TAVR procedure was only available for patients with severe condition aortic stenosis. But, lately, it is preferred more over open-heart valve surgery as an alternative.

It involves the placement of a new valve over the patient’s diseased valve via a catheter inserted through the femoral artery (large artery in the groin). The doctor will insert a short tube called a sheath. It will be placed on a delivery system and compressed on a balloon. Once it reaches the narrow valve, it inflates and opens a new valve within the diseased valve. Once it is done, the balloon will be deflated and then removed. It is now when the new valve starts working. In the end, the sheath is then removed and the incision in your leg is closed.

After the procedure is done, the patient is kept under observation in ICU for 12-48 hours.  Multiple post-operation tests are also conducted to check if the surgery is successful. Once you are stable, you will be kept in the patient room for 1 or 2 days more for routine check-ups and then discharged once the doctor gives you a green signal.

Every medical procedure, no matter how big or small it is – has its pros and cons. However, it is good to know that when it comes to TAVR, the risk is very moderate. There are also continued technological advancements to evade these minimal existing risks.

Now, let us know about open-heart surgery and how different it is from the TAVR procedure.

Open Heart Valve Surgery is being practiced for more than 50 years now. It’s a procedure to treat the heart valve. It is performed when one of the four heart valves stops functioning. Your surgeon may repair or replace heart valves. It is done by cutting your chest through your breastbone. The surgeon stops the heart and turns over circulation to a heart-lung bypass machine. The damaged valve is removed entirely and replaced with a new and functioning one. The new valves make sure blood keeps moving in the right direction.

There are quite a few risks involved in open-heart surgery. They can lead to bleeding, heart attack, infection, valve dysfunction, stroke, arrhythmia, etc. These risks may be averted depending on the expertise of the doctor. Hence, it is important to take regular medicines to post the surgery and keep a tab on your health.

Open heart surgery is still preferred for younger patients, those with congenitally malformed valves, and other specific cases where the probability of risk factors are comparatively less.

How is the TAVR procedure different from open-heart valve surgery?

Open heart surgery is an invasive procedure and involves a longer recovery time. It is also challenging for patients above 65 years of age and involves major risk factors during the surgery.

Whereas, TAVR valve replacement is a minimally invasive modality for patients who are either too old, are unwilling or at a risk to undergo open-heart surgery.

This can be done through small openings and hence result in quicker healing time.

There is less trauma to the chest and heart muscle tissue. Hence, there is less pain associated with TAVR.

In open-heart surgery, the heart is stopped. But, during TAVR, the heart keeps beating. Hence, there are lower risks of complications.

Once the surgery is done, biological valves often eventually need to be replaced, as they degenerate over time.

If you have a mechanical valve i.e. a replacement valve made with strong and durable material, you’ll need to take blood-thinning medications for the rest of your life to prevent blood clots. But when done so, it is important to talk to your doctor about the pros and cons of getting a TAVR  as an alternative over open-heart valve surgery – depending upon the patient’s medical history and other factors.

With multiple clinical trials, medical experts have usually preferred TAVR over open-heart surgery keeping in mind the patient’s health. The patients can have a more active and energetic life and regain the ability to perform daily routines. Additionally, there is less anxiety, shorter hospital stays, quicker recovery time, better heart health, and no scars on the body. With the advancement in technology, the TAVR procedure is usually preferred by doctors in India and also elsewhere because of its minimally invasive nature. There are many TAVR hospitals in India that perform the procedure and the patients have also reported quality of life improvements within 30 days post-TAVR procedure

So, talk to your doctor about TAVR today!

Studies show that heart disease is the leading cause of death worldwide. And, aortic stenosis is the most common valvular heart disease and the third most common cardiovascular disease after hypertension and coronary artery disease in the western world. It is also often referred to as a disease of the elderly however a lot of young adults have also been diagnosed with aortic stenosis. The disease can occur in a single valve or in a combination of the four valves.  Usually, aortic stenosis is most common in heart’s aortic valve and mainly occurs due to the buildup of calcium deposits that narrows the valve.  When it comes to the treatment for aortic stenosis, it completely depends on the severity of the patient’s condition. Suggesting a valve replacement surgery or advising patients with medication and lifestyle changes completely depends on the doctor. But, it is important to understand that no pill can cure aortic stenosis completely but there are few medications that may help in lowering down the risk and complications involved. Let us now look at the treatment choices available for treating aortic stenosis along with its cost in India.

Treatment of Aortic Stenosis

Aortic stenosis is a progressive disease, which means it will get worse with time. Due to this, aortic stenosis is measured as mild, moderate, or severe stages depending on how damaged your aortic valve is. Treatment options for aortic stenosis generally range from simple medications such as statins or surgical repair or replacement of the diseased aortic valve. No pill can cure aortic stenosis, but medication like statins can help you lower your cholesterol which can control your symptoms and lower the risk of heart attack and stroke for some time. However, anyone with aortic stenosis should be checked with an echocardiogram to determine treatment options. Although, medication may be appropriate only for a person for whom surgery is not an option or for someone who’s aortic valve condition is in a very mild stage without any major visible symptoms.

In most of the cases, aortic stenosis treatment requires surgical treatment to protect the heart from further damage. Generally, surgery for aortic stenosis treatment depends on each patient’s unique requirements and factors responsible for their condition. Two of such major surgical treatment options for aortic stenosis include aortic valve replacement and Balloon/surgical Aortic Valvuloplasty (BAV).

  • Aortic valve replacement: In this procedure, your diseased aortic valve will be replaced with the mechanical valves made of metal or with valve tissue from pigs, cows or human donors using traditional open-heart surgery or Transcatheter Aortic Valve Replacement (TAVR).  Undergoing a TAVR surgery is a better treatment option as it is a minimally invasive procedure involves placement of a new valve over the patient’s diseased valve via a catheter inserted through the femoral artery and hence result in quicker recovery post procedure enabling the patients to go back to their normal lives.
  • Balloon/surgical valvuplasty (BAV): It is a less invasive procedure because it is done by inserting a long flexible tube with a deflated balloon on its tip into the blood vessel from the groin. When the tip reaches the valve, the balloon is inflated which helps to open up the stenotic or stiffed heart valves and increase the blood flow through the heart.

Why consider India for aortic stenosis treatment?

According to doctors, aortic stenosis treatment in India can be obtained at highly economical rates as compared to the Western world. Due to low treatment cost and a high level of expertise for cardiac diseases including aortic stenosis, India has become a leading destination for medical tourism in the world. Generally, the treatment cost for aortic stenosis in India depends upon multiple factors such as the selected treatment procedure, used technology, the severity of the disease, location, pre- and post-operative care demanded and other selected services. However, irrespective of any procedure selected for aortic stenosis treatment such as a SAVR, TAVR or balloon valvuplasty, the cost is less than the hospitals in western countries. People visiting India for treatment are not only from neighbouring countries like Bangladesh, Afghanistan and Nepal but also from far off countries like Kenya, Nigeria, Iraq, Yemen, Kazakhstan, Iran, Uganda and Oman. In India, aortic stenosis treatment is preferably carried out at a number of well-renowned multi-specialty and super-specialty hospitals located across a number of metropolitan cities of India such as Mumbai, Delhi, Chennai, Hyderabad, Pune, etc. These hospitals offer world-class facilities and doctors who are well-versed in performing these surgeries, even in the most challenging situations.

According to global standards, the cost of aortic stenosis treatment in India ranges from a few thousand rupees a month. As per an estimate of 2016, the mean cost for TAVR procedure in the US were 69,592$ vs 58,332$ for SAVR. As compared to these estimates, TAVR cost in India is roughly half (34,900$) to that of the US hospitals. In simpler terms, the cost of TAVR surgery in India is estimated to be 18 to 20 lakhs which is 3 times lower versus any hospital in the western world.

These numbers along with the quality of treatment provided in India and effectiveness of TAVR are clearly responsible for a spike in the numbers of international patients. This means that the trend has clearly changed in the past decade in terms of treating a faulty valve and allowing individuals to live those additional years with greater quality of life or in an improved health state.

TAVR (Transcatheter Aortic Valve Replacement) is a fairly new therapy that has been developed in the last 15 years. It is a minimally invasive procedure invented to replace the diseased valves of the heart. Because of its high success rate and relatively less complicated nature as compared to the open heart approach, today TAVR therapy is at the top of the list when it comes to treating Aortic stenosis. From Europe to the United States to the Asian countries, TAVR therapy clearly is the preferred option for most of the surgeons in the new-age era. 

Earlier, more than 50 percent of patients were not recommended surgery due to various factors such as old age or other medical conditions. With TAVR entering the scenario, it has become easier for patients with complications to opt for better options. While TAVR comes with lower risk, it gives helpful treatment choices to individuals who might not have been otherwise considered for valve replacement. You are more likely to spend less time in the hospital after TAVR and it comes with fewer complications as compared to surgical valve replacement. 

If by any chance you have been lately identified with severe aortic stenosis then need not to panic. The best advice is to seek immediate medical care. The earlier you’ll pay medical attention, the quicker you’ll be able to get back to your normal life. Usually, your doctor determines the best possible way for replacing your faulty valve with a procedure that suits best for you. With TAVR, a small incision is made in the leg and hollow tube called a sheath is inserted into your femoral artery.

The thought of a heart valve replacement can be frightening. Fortunately, the less invasive TAVR is an option for more patients unlike earlier. Presently, only two Indian companies are making valves. TAVR is being performed in around 30 centers in India. Out of these centers, only 7 are considered to be the major ones. This is significantly less than the total number of cath labs present in India. The progress for TAVR in India remains rather slow with barriers at various levels. The probable reasons for such a lower number could be:

  • Reluctance among professionals.
  • High operative cost as compared to other procedures.
  • Regulatory approvals.
  • Lack of dedicated heart teams and specialized centers.
  • Lack of proficiency in TAVR.
  • Anatomical constraints amongst Indians not suited for the procedure.

As per the latest evidence, the average life expectancy post TAVR largely depends on the age factor of a patient. For example, for a 50-year-old patient, the average life expectancy is 31.5 years while it is just 4.6 years for a 90-year old patient. As per trials, the survival benefits are very limited when treating octogenarians (people between the age of 80-89 years) with TAVR. Also, co-morbid conditions of the patients such as diabetes or hypertension have a significant impact on the survival of patient after TAVR. More importantly, the quality of life in terms of activity and overall health receive a substantial boost after TAVR which is more beneficial in old age as compared to mere living.

As per an estimate of 2016, the cost for TAVR procedure in the US was 69,592$. As compared to these estimates, TAVR cost in India is roughly half (34,900$ i.e. Rs 26,11,387) to that of the US hospitals. In simpler terms, the cost of TAVR surgery in India is estimated to be 18 to 20 lakhs which is 3 times lower versus any hospital in the West. However, this cost is around six times higher vs. open-heart surgery. But, open-heart surgery is not suited for every patient. Particularly, for elderly patients with co-morbidities who are deemed to be at high surgical risk and form the major patient population. Hence, they need to undergo TAVR. At this moment, this procedure sets an extremely daunting task for the surgeons and the patient’s family to manage such a huge expenditure. Technical innovation in terms of device and procedural advancements coupled with the availability of indigenous device may ultimately aid in reducing the huge cost of this extremely useful treatment.

The choice to treat aortic stenosis with TAVR is made after you ask a group of heart surgery specialists, who cooperate to decide the best treatment option for you. Without a doubt, TAVR therapy is changing the trend and is already proving to alleviate the signs and side effects of aortic valve stenosis. With local manufacturers entering the space with top-notch products satisfying all the necessary standards, TAVR therapy seems to be the best possible option available for treating aortic stenosis even in India.

The heart is one of the most important organs in the human body. The function of the heart is to pump blood. The human heart has four chambers. Each chamber has its own valve to make sure blood flows in the right direction. Before leaving the heart, the aortic valve is the final one amongst the four valves through which the blood flows. The aortic valve’s task is to pump blood that is rich in oxygen into the largest blood vessel in your body, referred to as the aorta.

The aortic valve has leaflets which open and closes during each heartbeat. In some heart diseases, the valve does not open or close properly disrupting the blood flow to the body. This may lead to the valve leaking and is called valvular regurgitation.

Another form of valve disease is valvular stenosis that commonly affects the aortic valve. This condition occurs due to calcium build-up on the leaflets leading to the stiffing of the valve. The severity of aortic stenosis increases with age and can be classified as mild, moderate, and severe. The stiffing of the valve prevents it from opening fully which reduces or blocks the blood flow from the heart to the rest of the body.

Your heart needs to work more than normal to supply blood to the entire body when the flow of blood through the aortic valve gets lessened or stops completely due to blockage. Eventually, this extra work limits the amount of blood it can pump, and this can cause symptoms as well as possibly weaken your heart muscle.

Calcium deposition in the valve, defects present in the heart from birth and strep throat infection (rheumatic fever) are a few of the causes of aortic stenosis.

Some people with aortic valve stenosis may not experience any symptoms for many years.

Signs and symptoms of aortic valve stenosis may include:

  • ·Abnormal heart sound (heart murmur) heard through a stethoscope
  • ·Chest pain (angina) or tightness with activity
  • ·Feeling faint or dizzy or fainting with activity
  • ·Shortness of breath, especially when you have been active
  • ·Fatigue, especially during times of increased activity
  • ·Heart palpitations — sensations of a rapid, fluttering heartbeat
  • ·Not eating enough (mainly in children with aortic valve stenosis)
  • ·Not gaining enough weight (mainly in children with aortic valve stenosis)

If you have the above symptoms, don’t worry. Visit your doctor today.