From battery-operated systems that keep the heart pumping to implantable cardioverter-defibrillators that control the heart’s rhythm, a long list of innovations has come to the rescue of the ailing heart. Smarter medications and less-invasive procedures have led to reduced risk and better patient outcomes. Dramatic leaps in technology have made alternatives to chest-opening surgeries possible. Today you can get a valve replacement for faulty heart valves, done through small openings.
For patients suffering from aortic stenosis, a degenerative valvular disease that worsens over time, transcatheter aortic valve replacement or TAVR is a blessing. This minimally invasive procedure repairs the aortic heart valve without removing the old, damaged valve. Instead, it places a replacement valve into the aortic valve's place through a catheter or tube inserted through the femoral artery (large artery in groin). These procedures can thus be done through small openings that leave all the chest bones in place thereby resulting in quicker recovery post procedure.
Need for a valve replacement
When a heart valve gets dysfunctional, the patient may experience typical symptoms like chest pain, palpitations, shortness of breath, fatigue, weakness, inability to maintain regular activity level, or even light-headedness. Medications can be prescribed to increase the heart’s ability to pump blood which may help compensate for a valve that is not working properly. However, a diseased heart valve is a mechanical problem that cannot be fixed with medication alone, and surgery is often needed to repair or replace the damaged valve. Once it is determined that a diseased heart valve needs treatment, the available choices are valve repair or valve replacement.
Till now, valve replacement was mostly done through open heart surgery wherein a new tissue—mechanical prosthetic valve—is inserted in place of the diseased valve. However, open-heart surgery is an invasive procedure. It is known to have a longer recovery time and may be challenging for elderly patients. The latest technology TAVR, being a minimally invasive procedure, is safe and effective for moderate to high-risk patients.
About 40 per cent of the patients who require a valve replacement for aortic stenosis are not offered the treatment, either because they suffer from some health complication or are too old to undergo surgery. Many among these patients voluntarily opt out of surgery, due to various factors. But now, with TAVR, they can get treated without surgery, which means lower risks and complications.
For patients who are above 60, not physically fit to undergo the surgery or for those might develop some other surgical complication, TAVR is a lifesaver.
The technology was introduced after robust bench testing, pre-clinical and clinical studies. As the principal investigator of one such products I can safely say that it has produced better patient outcomes and has proved a successful alternative to treat aortic stenosis. It is safe, applicable to most patients, and effective. Having performed the highest number of TAVR procedures in India, I can confidently say that the procedure has yielded remarkable results. It holds genuine hope for individuals who are at high-risk for open-heart surgery.
Additionally, the complication rates of doing a TAVR procedure are very low. There are hardly any patients needing a pace maker implantation post procedure and as the technology has evolved, the complications have further gone down.
Dr Ravinder Singh Rao is an interventional cardiologist and director of TAVI & Structural Heart Disease Program, EHCC, Jaipur.
BENEFITS OF TAVR
■ Faster recovery when compared to surgery
■ Low risk, minimal complications
■ Safe and effective for moderate to high-risk patients
■ Less demanding post-operative care