Over the years, in countries like India, the medical fraternity has witnessed plenty of diseases and has treated patients with various ailments. As per WHO, “Cardiovascular disease is the leading cause of death across the globe, taking an estimated 17.9 million lives each year.”
As per independent reports, adults aged 65 and above are at a higher risk of developing cardiovascular diseases than the younger population. Our heart valve muscles can weaken or become damaged as we age, which is why older people are commonly diagnosed with valvular diseases. One serious type of heart valve disease is called aortic stenosis (or aortic valve stenosis). This is the most common type of heart valve disease in the elderly. In this condition, an aortic valve cannot fully open and close like it should, and over time, this can become life-threatening. The sooner you talk to your doctor, the sooner you can learn about treatment to get back to a healthier you.
What are the different procedures available for curing Aortic Stenosis?
Once your aortic stenosis becomes severe and you start to have symptoms, immediate treatment is important. The only effective way to treat severe aortic stenosis is by replacing your heart valve. This can be done through transcatheter aortic valve implantation (TAVI) or open-heart surgery. In the past, open heart surgery was the only way to replace an unhealthy valve. TAVI was approved in 2008 as an alternative treatment option for people with severe aortic stenosis. Your doctor will request several tests to determine the best treatment for you. Once your doctor has determined you need aortic valve replacement, they may refer you to a Heart Team at a specialized Heart Centre who can evaluate you for all your treatment options. Heart Team is a group of qualified healthcare professionals who work together to determine the best treatment plan for each individual patient.
Open heart surgery is a traditional form of surgery where the heart is cut open to performing the surgery on valves. However, in severe cases, individuals are advised to undergo heart valve replacement (TAVR/ TAVI). These procedures not only mitigate the periprocedural events but are also useful as a surgical aortic-valve replacement in the long run. Open Heart Surgery is performed through an incision in the chest and requires a patient be placed on a heart and lung blood machine while under general anesthesia.
TAVI, also called TAVR (transcatheter aortic valve replacement), is a less invasive treatment option for severe aortic stenosis, that is designed to replace a diseased aortic valve. A small incision is made in your upper leg. This is where your doctor will insert short hollow tube called sheath into your femoral artery. New valve compressed & placed in delivery system passes through sheath. Delivery system carrying valve is pushed to aortic valve. Once it reaches diseased valve, new valve pushes aside leaflets of diseased valve. Your existing valve holds new valve. And new valve starts functioning immediately
When should people opt for TAVI/TAVR?
Heart valve disease can cause the blood flow from heart to body to be disrupted. If body is not getting enough oxygen this can lead to some of these typical symptoms:
● Shortness of breath
● Chest pain
● Fatigue (low energy)
● Lightheadedness, feeling dizzy, and/or fainting
● Difficulty when exercising
● Swollen ankles and feet
● Rapid or irregular heartbeat
Studies have shown that while many patients initially report no symptoms, after closer examination, 37% do have symptoms.
An interventional cardiologist is likely to conduct a minimally invasive procedure, TAVI (Transcatheter Aortic Valve Implantation), or TAVR (Transcatheter Aortic Valve Replacement) on individuals who are having symptoms of heart valve diseases supported by diagnostic evaluation by Echo.
Who is eligible for the procedure?
Recent clinical study PARTNER III has proven TAVR/ TAVI procedure to be superior than open heart surgery in patients who are low risk for surgery. This procedure was already approved for patients who are at high and intermediate risk for surgery. So TAVR/TAVI can be performed on following set of patients
● Elderly Symptomatic severe aortic stenosis patients at all risk levels
● Patients with aortic stenosis who are not fit for surgeries
● Patients who have surgical bioprosthetic valve which was inserted to replace the original aortic valve, but it is not functioning well anymore.
What are the things to keep in mind before and after undergoing the procedure?
Before the TAVR/TAVI procedure, try and understand the precautions to be taken pre and post-procedure. It is advisable to clarify doubts (if any) by asking your medical professional.
The duration of the stay in hospital post-procedure may not be as elongated as the other procedures and are likely to spend a maximum of 2 days in the ICU. Post ICU, they would be required to stay in a patient room for another 2-3 days. That said, treated individuals are likely to resume walking in 1 day and are permitted to carry out small activities in 2-3 days of the procedure. Regardless of the recovery and depending upon the condition, individuals are advised not to resume strenuous physical activities until permitted by their medical professionals.
Remember, it is imperative to keep your medical professional informed about your health and revisit them (for every 30 days to one year) after taking the TAVR procedure for further monitoring of your condition. Additionally, in case you face any health changes and discomfort, make sure you consult the doctor immediately.
(Disclaimer: The author is Dr. G Sengottuvelu, Senior Consultant & Interventional Cardiologist at Apollo Hospitals, Greams Road, Chennai. Views expressed are a personal opinion.)