A 67-year-old man with interstitial lung disease (disorders causing gradual scarring of lung tissue) presented at a hospital in Mumbai with complaints of chest pain and breathlessness. An echocardiogram revealed that his aortic valve had narrowed — a condition known as aortic stenosis. The man also suffered mild aortic regurgitation, a heart valve condition where the aortic valve does not close properly and leaks blood into the left ventricle. Dr Ravinder Singh Rao, interventional structural cardiologist, RHL Hospital, Jaipur, successfully treated the patient. He performed transcatheter aortic valve implantation (TAVI), where a small catheter was inserted in the femoral (groin) blood vessel and advanced to the heart, in the catheterization laboratory under conscious sedation. The new valve, positioned correctly and deployed inside the old valve, started functioning immediately.
Following this, a CT angiography was performed, which revealed 90% blockage in the left circumflex coronary artery. Therefore, to open the blocked coronary artery, Dr Rao and his team proceeded to perform a coronary angioplasty. The entire procedure (transcatheter aortic valve implantation and angioplasty) was completed in the same sitting within 60 minutes. Post-procedure, the patient was hemodynamically stable with a good clinical outcome.
What is transcatheter aortic valve implantation?
Severe aortic stenosis, where the aortic valve narrows and blood cannot flow normally, can put pressure on the heart over time. This was previously fixed with an open-heart surgery. However, TAVI is a minimally invasive procedure that can be used to treat this condition, and it offers several more advantages, shares Dr Rao.
Dr Srinivas Prasad, senior consultant, interventional cardiology, Fortis Hospital, Bangalore, says, “TAVI is less invasive than traditional open-heart surgery and is often used for those who are at high risk or not suitable for surgery”. He explains that here, a long, thin catheter is inserted into an artery, usually in the groin, and guided up to the heart. The doctor uses fluoroscopy (imaging technique to obtain real-time videos of the inside of a part of the body) to navigate the catheter’s position. The new valve is delivered through the catheter and positioned inside the diseased aortic valve. Once the catheter reaches the heart, the new valve is expanded, effectively restoring proper blood flow through the heart.
When is TAVI considered over open-heart surgery?
As a minimally invasive procedure, TAVI or transcatheter aortic valve implantation has its benefits. Talking about the 67-year-old treated in Mumbai, Dr Rao shares that he was considered to be high-risk for open-heart surgery due to his pre-existing conditions. Dr Rao further adds that those who suffer from severe symptomatic aortic stenosis tend to be suitable for the TAVI procedure. However, they could also be suitable candidates if they are unlikely to survive the stress of open-heart surgery due to factors like old age, frailty and other underlying health conditions.
The medical team thoroughly evaluates the person concerned, looking not only into the medical history but also at the anatomy of the aortic valve and surrounding structures as well as previous cardiac interventions, if any.
Benefits of transcatheter aortic valve implantation
According to Dr Rao, the recovery time is much shorter after TAVI. Besides, there is a reduced risk of complications like infection or bleeding. However, experts choose between TAVI and open-heart surgery depending on a patient’s history and the severity of their condition.
Dr Rao adds that while the recovery process is typically shorter for transcatheter aortic valve implantation, a certain amount of rest is required. Recovery might take a few days or even a few weeks and varies from patient to patient.
Risks and complications
While TAVI is considered safe and effective, the risks and complications associated with TAVI are the same as any cardiac procedure which could include stroke and vascular complications, says Dr Rao. He adds that the likelihood of such issues is lower compared to traditional open-heart surgery, and the likelihood of complications depends on factors like the person’s age and condition, the specific technique used and the experience of the medical team.
“The TAVI procedure is incredibly successful in improving the quality of life of people suffering from aortic stenosis and relieving their symptoms, especially for those who cannot be considered for open-heart surgery. Clinical studies show improved survival rates with TAVI as compared to more conservative methods of treatment”, says Dr Rao.
Post-TAVI precautions
Dr Rao recommends making certain lifestyle changes and taking precautions that will optimize recovery and long-term outcomes post-TAVI. These include consuming a balanced, heart-healthy diet, engaging in regular physical activity as advised by the medical team and quitting unhealthy habits like smoking.
Other precautions include managing stress and consistently taking prescribed medication. People who undergo this surgery should also attend check-ups and screenings to ensure that they stay healthy and check on the health and functioning of their aortic valve.
Dr Prasad adds that it is advisable to keep blood sugar level, blood pressure, and cholesterol under control so that the valve will survive longer. This is because the degradation and cholesterol depositions will be significantly reduced, improving valve health.
Takeaways
- TAVI or transcatheter aortic valve implantation is a minimally invasive procedure treatment option for severe aortic stenosis.
- In this procedure, a new valve is inserted through a catheter to restore the blood flow.
- It is recommended for those who are aged or frail, and those with certain health conditions.
