Advanced TAVI is replacing the need for open heart surgery

New Delhi: The advanced technology of TAVI or Transcatheter Aortic Valve Replacement has given hope of a new life to the geriatric population suffering from vascular disease.

In Western countries, TAVI has now become the most common go-to cardiac operation when it comes to minimally invasive surgical procedures for valve replacement. With almost 95 percent success rate, TAVI is considered to be the gold standard treatment for older and frail patients suffering from aortic-stenosis, who have been excluded from under-going open heart surgery before due to high risk.

The heart has four valves – mitral valve and tricuspid valve control blood flow from the atria to the ventricles, while aortic valve and pulmonary valve control blood flow out of the ventricles. In short, the basic function of valves is to allow seamless flow of blood through the heart. When any of those valves are dysfunctional then previously an open heart surgery was performed to replace them. Now with TAVI procedure the valves can be substituted without opening the heart. This procedure is done through the leg artery via groin, where a catheter is passed all the way to the heart. By insertion of a prosthetic catheter through the circulatory system, the old valve is replaced with the new valve which immediately starts working for regulating blood flow.

Open heart surgery is very risky for people over 50 year of age, who can’t undergo the rigors of this operation. With overall technological advancement across the world, the mortality rate is decreasing quickly and people are living longer these days, especially in Western countries. As older people are more prone to succumbing to such cardio-vascular disorders, they are also at risk when open heart surgery is performed on them. The most common symptom patients of aortic-stenosis face are chest pains, extreme breathlessness if they exert themselves and they may suffer fainting spells also.

Aortic stenosis, the progressive failure of the aortic valve to open fully, is the commonest type of valve disease in elderly people. It is usually treated by valve replacement surgery, but around a third of those who might benefit are turned down because the risks of surgery are too high or because problems such as a calcified aorta or scarring from previous surgery make them unsuitable for surgery. Untreated, most will die within five years. TAVI offers an alternative, in which a replacement valve is introduced through an artery via a small incision (usually the femoral artery) or, less often, surgically with an incision into the chest and then into the left ventricular apex—the transapical approach.

After going through a complete pre-surgery check-up including CT scan, X-Ray, blood test, the expert physicians recommend TAVI which has now been proved to be one of the most cutting-edge surgical treatments by medical community across the world. Though TAVI is relatively expensive and few people can afford it.

“TAVI is safe and more effective than open heart surgery as there is no blood loss, much less risk of infection and fast recovery is possible. In India close to 200 surgeries have been done to far, whereas in Eastern India hardly 1-2 have been done till now. TAVI is undoubtedly more suitable for most of the patients suffering from aortic stenosis,” says Dr Anjan Siotia, Department of Cardiology, CK Birla Hospitals – BM Birla Heart Research Centre that is among the top hospitals that offer the advanced surgery.

In most of the Indian hospitals, there is the facility of cardiac Intensive Care Units as well as good post operative diagnosis, which leads to proper care after the operation. With tens of hospitals including Apollo Hospitals and Fortis Healthcare in various major cities already offering it to the patients, this latest technology is fast gaining its pace, replacing the conventional heart surgery, especially in extreme cases.