TAVR Is A Minimally Invasive And The Most Effective Treatment For Aortic Valve Disease: Dr. Rahul Gupta

TAVR, TAVI or Transcatheter Aortic Valve Replacement has been one of the most advanced treatments for severe aortic stenosis (calcification and severe narrowing of the aortic valve that regulates the flow from heart to the entire body), and has a success rate of over 99% with minimum invasive procedure in comparison to open heart surgeries.  

Aortic stenosis is a cardiovascular disease that progresses with age and is usually detected in senior citizen above the age of 65 years and above, but there have been many instances of these symptoms been prevalent in younger person in the age group of 40 years and above.    

This World Heart Day, Dr. Rahul Gupta, Senior Interventional Cardiologist & TAVI expert at Apollo Hospital informs ‘Blood supply from the heart to the body is obstructed due to narrowing of the valves due to age related calcification and some other causes and can be life threatening, if not treated. TAVR provides a far effective treatment option that is non-invasive and requires lesser hospitalization days for recuperation’. 

How does narrowing of the aortic valves occur? 

The most common reason for narrowing is age related calcification of the aortic valve which happens with ageing. This process is hastened in people with uncontrolled blood pressure and high cholesterol and these risk factors should be taken care of well. The other causes are rheumatic affection due to rheumatic fever in childhood and defects in the valve from birth itself. 

What are the various symptoms that are associated with aortic stenosis? 

Stenosis means narrowing of the valve and aortic valve is the gate keeper between the robust pumping chamber of the heart (the left ventricle) and the Aorta which is the biggest pipeline of the body and supplies the blood to all the organs in the body through its branches. Mild and medium narrowing do not produce symptoms but severe narrowing can hamper the blood supply to all the organs and also the heart has to work very hard to push the blood through the narrowed valve. Initially the heart muscles get thickened to pump harder but later fatigue can set in and the heart begins to fail.  

The initial symptoms are breathlessness on exertion like walking climbing stairs etc., with progression person may experience chest discomfort due lack of blood supply to the heart muscles, and dizziness or blackouts due to lack of supply to the brain. If these symptoms are ignored person may land up in heart failure which will cause extreme breathlessness swelling over the feet and sudden cardiac death. 

If somebody has these symptoms it should not be ignored. It just takes a simple echocardiography test to diagnose valve problems. Echocardiography is the sonography of the heart. 

Is aortic stenosis associated with age or are younger people too susceptible to it? 

More commonly seen with advancing age but younger people can also develop it due to birth defects or rheumatic fever in childhood. 

What is TAVR and how effective is the treatment? 

There are two treatment options for replacing the valves. Traditionally it has been open heart surgery where you cut open the chest, expose the heart and replace the valve. This treatment still holds the fort for younger patients who needs the metallic valve. The more advanced option is TAVR or TAVI which is replacing the aortic valve without open heart surgery. It is usually done in people who are 65 years or older and sometimes in younger people where surgery is not possible. TAVR valve is a tissue valve and hence it can be folded into a catheter which is inserted through an artery in the thigh just like we do in angioplasty under local anesthesia and mild sedation. We can talk to the patient during the procedure which usually takes one to two hrs. The success rate is more than 99%. 

Why is TAVR preferred over open Heart surgeries? 

Wherever indicated TAVR is superior to open heart surgery as the recovery is fast, ICU stay is less than 24 hours and hospital stay is usually not more than 48hrs.Most of the time it is done under local anesthesia while open heart surgery has to be done under general anesthesia. The chances of complications are also lesser. Patient can be mobilized and moved out of bed and can eat and drink like a normal person within few hours of procedure. 

At the same time it is also true that in some patients open heart surgery will be superior. We have a heart team which comprises of Cardiologist, Cvts surgeons and Imaging specialist and each and every case is discussed to decide the best strategy for a given person. 

Are there other advanced valve therapies?  

Yes, there is significant advancement in the non-surgical treatment of valve diseases. Mitra clip is one such procedure for severe Mitral regurgitation. TRIC valve is for severe tricuspid regurgitation and pulmonary valve replacement for pulmonary valve disease. There are more exciting therapies in pipeline which will make all kind valve problem treatable without open heart surgeries. 

Are these technologies available in our country? 

Most of these therapies are available and we almost get these at the same time or with some delays due to high cost. However even before launch we continuously upgrade our skills and knowledge to learn these advance therapies so that patients in our country can get best of the treatment at a lesser cost as compared to the western world. 

On World Heart Day, what would be your advice to keep Heart Healthy?     

Heart diseases are number one killer worldwide and to reduce its incidence we need to follow a healthy lifestyle. I advise people to follow the 6E formula to make them heart attack proof.  

1. Eat healthy timely and peacefully.  

2. Exercise most of the days and include cardiovascular, stretching and toning kind of exercises. Consistency is the key and gives magical results through the power of compounding.  

3. Emotionally be happy optimistic and positive. Meditations pranayama positive affirmations keep the emotional health upbeat helps us to be stress free.  

4. Exit all addictions.  

5. Enough good quality sleep is important to repair wear and tears in the body and mind. 6-8hrs of deep sleep is needed by the most. If you are not fresh after adequate sleep you may be having sleep apnea due to heavy snoring. So check and rectify.  

6. Evaluate your risk factors like high BP, Sugars, cholesterol and weight as they are all silent killers and you will not know that you have them until you check them. So have regular health checks.  

If one follows all this, they will have a healthy heart and a healthy life. 

Dr. Rahul Gupta, MD, DM Gold Medalist is an Interventional Cardiologist and Valve Expert (TAVI, Mitra Clip) in Mumbai & Navi Mumbai. He is also a Senior Consultant at Apollo Hospitals and the Director at Cardium Advanced Heart Care Clinic.