Overview

Transcatheter aortic valve implantation (TAVI) procedure is a minimally invasive heart technique to replace a damaged aortic valve which is narrowed and does not open properly, in medical terms it is called as aortic valve stenosis. Transcatheter aortic valve implantation is sometimes referred to as transcatheter aortic valve replacement (TAVR). TAVI can be a viable option for patients who are at moderate or high risk of complications from surgical aortic valve replacement i.e. open-heart surgery. Thus, TAVI or TAVR as an option to treat symptoms of aortic valve stenosis can improve survival chances in patients.

Masina Heart Institute is one of the leading centre for TAVI procedure in Mumbai. We did the first double (Aortic & Mitral) transcatheter valve implantation in same setting in India. We have backup surgical support team & facility at our centre. Our heart team is a specialized care team that includes interventional cardiologists, cardiothoracic surgeons, imaging specialists and anesthesiologists. Together, the specialized Heart Team conducts a comprehensive evaluation to determine whether the TAVI procedure is appropriate for you.

Transcatheter Mitral Valve Repair (TMVR) is a minimally invasive procedure for treatment of patients with high or intermediate symptomatic chronic mitral regurgitation. TMVR has emerged as an exciting new technique in cardiac structural interventions.

Transcatheter Aortic Valve Implantation (TAVI) has become a well-proven and effective treatment model or procedure for patients with severe symptomatic aortic valve stenosis (AS) requiring valve replacement at high or intermediate surgical risk.

Why is it done?

Aortic stenosis (AS) situation, commonly known as narrowing of the aortic valve, is caused due to factors such as age, genetic makeup, rheumatic fever, or build-up of cholesterol (fat), calcium deposits on the valve tissues or leaflets making it difficult for the valve tissues to open or move easily and further decreases the pumping efficiency of the heart to push blood to the body. It may also cause regurgitation, explained as backflow of blood through a defective heart valve, as the valve gets damaged or worn out the blood is able to leak backwards. This makes the heart work harder to circulate the blood and if left untreated, can result in heart failure or even sudden death. Thus TAVI or TMVR is a kind of boon for such cardiac patients.

Who benefits most from TAVI / TAVR

TAVR / TAVI may be beneficial when;

• Patients have aortic stenosis symptoms
• Patients have moderate or high risk of complications from surgical aortic valve replacement.
• Kidney and lung disease can increase your risk of complications during open heart surgery or surgical aortic valve replacement.
• Patients have an existing biological tissue valve but it isn’t working well anymore.

Benefits of TAVI / TAVR

Potential benefits of TAVI are less intra procedural haemodynamic perturbation from general anaesthesia, shorter ICU and hospital stays, earlier ambulation of patients, huge relief and increased satisfaction for patients and immediate families.

Risk of TAVI / TAVR

Like all major medical procedures risks of transcatheter aortic valve implantation (TAVI) may include:

• Bleeding
• Blood vessel complications
• Stroke
• Infection
• Arrhythmias
• Pacemaker
• Lower Limb Vascular Complications

But if the doctor’s teams are seasoned and well versed, these risks can be mitigated or avoided.

How it is done?

A hollow tube is inserted in your leg at the groin. The diseased valve is crossed via a catheter & wire, the valve which is crimped on the balloon is then placed across the native diseased aortic valve. When the position is confirmed the TAVI valve is then inflated and the native diseased leaflets are pushed aside due to the TAVI valve. The new valve starts functioning immediately causing release of the stress on the heart.

The patient is observed in the ICCU for 24hrs for change in rhythm and requirements of a pacemaker. Post procedure the patient is discharged after 48 – 72hrs.

Valve used in this procedure

• MyVal by Three Life Science Meril
• Core Valve Evolut by Medtronic
• Sapien Valve by Edward Life Science

Post Procedure Care

Post TAVI procedure, a patent will need regular follow-up appointments with their doctor. Patients are required to take certain medications after TAVI procedure. The doctor will discuss and advise how long medication is to be taken. Artificial heart valves implanted through TAVI, can become infected with bacteria. Most of the time heart valve infections come from the bacteria in the mouth. Excellent oral and dental hygiene is a must. After the procedure, the patient is required to live and make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.