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.
• 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.

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.