Heart valve replacement in 82 year old

A pioneering cardiac procedure, percutaneous Transcatheter Aortic Valve Replacement (TAVR) was performed on an eighty-two-year-old man with critical calcific Aortic Stenosis at Citizens Specialty Hospital, Hyderabad. The team of specialists was led by Dr. A Sreenivas Kumar, Consultant Cardiologist and Chief of Cardiac Services, Dr Gokul Reddy, Consultant Cardiologist and Director of Cath labs and assisted by Dr V Hariram, Sr. Consultant Cardiologist, Dr E Sanjeev Kumar, Sr. Consultant Cardiologist, Dr Sudheer Koganti, Consultant Cardiologist and Dr J Ramakrishna, Consultant Cardiologist. Dr. Vikram Aerra, Sr. Consultant CT Surgeon, provided surgical back up.

Dr Venugopal and Dr Viswanathan looked after anesthetic aspects. Dr Ravi Bathina helped with non-invasive imaging and in getting all valve measurements on CT scan. Till date, only handful of procedures have been performed in the city of Hyderabad and combined Telugu states.

Narrowing of the aortic valve, one of the four valves of the heart is called Aortic stenosis. Aortic stenosis is a mechanical problem in which the leaflets of the valve are fused to such an extent whereby there is a mechanical obstruction to blood flow as it is ejected by left ventricle, the main pumping chamber of the heart. This leads to exertional breathlessness, chest pain, dizziness and heart failure in some. Left alone patients develop symptoms due to severe heart failure or abnormal heart rhythm and succumb to it.

Conventionally aortic valve is replaced with either a tissue or bioprosthetic valve by open-heart surgery. Increasingly TAVR is also becoming an alternative particularly in those that are considered at moderate to high risk for open-heart surgery. Our patient was deemed to have at least moderate risk due to his advanced age and chronic kidney disease and therefore was considered for the minimally invasive TAVR.

TAVR for this patient was performed in the cathlab from the groin region (right femoral artery) just like in angioplasty. Once the patient was anaesthetised, Evolute – R percutaneous arotic valve (made by Medtronic USA) was advanced to the heart through the femoral artery, positioned accurately under the guidance of fluoroscopy and then implanted. The whole procedure was completed in 90 minutes. Immediately after the procedure the patient was extubated and shifted to surgical ICU. Following adequate recovery, he was discharged home 3 days later.

TAVR is routinely performed in high numbers in the western world for patients who are at moderate to high risk for Open Heart Surgery. Slowly but steadily the number of TAVR procedures performed are increasing in India. However, cost of the valve remains prohibitive and with Indian valves on the horizon this may come down too. TAVR is now a life-saving procedure for patients with aortic stenosis who are not fit for open heart surgery and we can offer this now at Citizens hospital.