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Cardiovascular TAVR

Overview

Overview of TAVR

TAVR stands for Transcatheter Aortic Valve Replacement. It is often referred to as TAVI (Transcatheter Aortic Valve Implantation).

The procedure is for individuals diagnosed with severe symptomatic aortic stenosis and are at intermediate or greater risk for open heart surgery.

The TAVR procedure allows a new valve to be inserted within the diseased aortic valve. During the procedure, the new valve pushes the leaflets of the current diseased valve aside. The frame uses the leaflets of the diseased valve to secure it in place.

TAVR is a less invasive procedure. It uses a catheter to replace the heart valve instead of opening up the chest of the patient and completely removing the diseased valve. It can be performed in multiple ways.

 

Understand if TAVR is for you

TAVR (Transcatheter Aortic Valve Replacement) procedure is for individuals who have been diagnosed with severe symptomatic aortic stenosis and are at intermediate or greater risk for open heart surgery.

How do I know if I am an intermediate or greater-risk patient?

There are several factors that determine whether or not you are at intermediate or greater risk for open heart surgery, and therefore, a possible candidate for TAVR.

5 major factors include:

  1. Age
  2. Current health status
  3. Medical history
  4. Your frailty
  5. Condition of your heart

Remember, each patient is unique. Talk to our Heart Team to assess you better.


Procedure

Preparing for the procedure

The Heart Team will conduct various tests or assessments, such as a chest X-ray, echo, angiogram, and others to review your condition.

It is important that you inform your Heart Team about any medication you may be taking. Your doctor will advise you about regulating your intake prior to the procedure.

 

During the procedure

  1. When the procedure begins, you may be placed under anaesthesia.
  2. An incision will be made in your leg (or slightly higher up), where your doctor will insert a short, hollow tube called the sheath.
  3. The doctor will then take a catheter through the sheath to reach your aortic valve. A catheter can be described as a long tube with a balloon on the end. The balloon is then inflated with fluid to open the narrowed valve. It is later deflated and removed.
  4. The new valve is placed on the delivery system and compressed on the balloon to make it small enough to fit through the sheath.
  5. The balloon is inflated with fluid, expanding the new valve with the diseased valve. During this valve expansion, the heart is stabilised by temporarily speeding up the heartbeat. The new valve then pushes the leaflets of the diseased valve aside. The frame of the new valve is strong and uses the leaflet of the diseased valve to secure it in place. The balloon is then deflated and removed.
  6. Once the doctor ensures that the new valve is working properly, the sheath is removed and the incision is closed.

The average procedure time varies from 1 to 2 hours.

 

Care after the procedure

The Heart Team determines immediate after-care plan

After the TAVR procedure, the patient may be taken to the ICU, or may be taken directly to the hospital floor.

Specific discharge advise

The Heart Team gives specific instructions to help with recovery, which may include a special diet, exercise, and medicine. It is important to carefully follow the doctorbs directions, especially if blood-thinning drugs are prescribed. The Heart Team will schedule follow-up visits with you.

You will be expected to attend regular check-ups

Regular check-ups with your doctor are very important. Call or see your doctor whenever you have questions or concerns about your health, especially if you experience any unusual problems such as bleeding, pain, other discomfort, or changes in your overall health.


Benefits

Here are some of the key benefits of the TAVR procedure

Quicker recovery time

TAVR helps your heart work better. It helps shorten the recovery time there by helping the patient get back to living life.


Less invasive procedure

The procedure is less invasive as compared to surgical valve replacement.


Shorter hospitalisation period

The average duration of hospitalisation usually ranges between 2-4 days as compared to open-heart procedure.


Quality of life improvement

The procedure has seen patient health improvements within 30 days, including: the ability to take care of themselves and ability to participate in everyday activities.


How does TAVR compare to surgery?

Over the last decade, multiple studies and clinical trials have proven the use of TAVR in high risk patients and demonstrated encouraging clinical outcomes. This then lead to comparing the use of the TAVR technology in intermediate risk patients and compare it with the standard of care i.e Surgical Aortic Valve Replacement.

TAVR in intermediate-risk patients was superior at 1 year to surgical valve replacement, with lower rates of death, strokes, and the composite endpoint of death, strokes, and moderate to severe aortic regurgitation combined.

Moreover, other infrequent but nonetheless important procedure-related complications, including coronary occlusion, annulus rupture, and device embolisation were also decreased after TAVR at 30 days.

Compared to surgery, TAVR also yielded significantly lower rates of acute kidney injury, severe bleeding events and new onset atrial fibrillation.

TAVR patients spent less time in the hospital overall b the average time in the ICU was about two days with TAVR versus four days with surgery, and the average hospitalization for TAVR was six days compared to nine days with surgery.

TAVR also appeared to improve the aortic valve areas more than surgery, meaning that the quality of the valvebs performance was better as measured by echocardiography during follow-up points through two years.


Factors that lead to such good clinical outcomes

The role of the Heart team and the proper selection of the patients have contributed to excellent clinical outcomes of TAVR. The improvement in device technology is not only making the adoption of the technology easier but also improving the short term as well long term clinical outcomes superior


Is TAVR the way forward ?

TAVR with the new generation valves demonstrates good clinical outcomes in patients with severe aortic stenosis who are at intermediate risk of surgical mortality.

Our Team

Full Time Consultant
Name Designation Qualification Availability
Dr. Chandrashekhar Kulkarni Full Time Consultant Cardio Vascular & Thoracic Surgery MBBS, M.S., MCh (CVTS), DNB, MRCS, Fellow Cardio Thoracic Surgery

Monday to Saturday :
8.00 am - 8.00 pm

Dr. Ganesh Kumar AV Senior Consultant Interventional Cardiologist and Co-ordinator MD (General Medicine), DNB (Internal Medicine), DNB (Cardiology), DM (Cardiology), Fellowship in Interventional Cardiology (Rambam Medical Center, Haifa), FACC

Consults with prior appointment only.
Call 022-25763595 / 25763298
to schedule an appointment.

Dr. Irfan Khan Hamid Full Time Consultant Cardiology DM (Cardiology), MD (Internal Medicine), MBBS

Monday to Saturday :
8.00 am - 8.00 pm

Dr. Rushikesh Sambhaji Patil Full Time Consultant Cardiology DM (Cardiology), MD (General Medicine), MBBS

Monday to Saturday :
8.00 am - 8.00 pm


FAQ

  • What is TAVR?

    TAVR stands for Transcatheter Aortic Valve Replacement. It is often referred to as TAVI (Transcatheter Aortic Valve Implantation).

    The procedure is for individuals diagnosed with severe symptomatic aortic stenosis and are at intermediate or greater risk for open heart surgery.

  • Is TAVR same as TAVI?
    TAVI stands for transcatheter aortic valve implantation. The procedure is not different from TAVR. Whether your doctor calls it TAVR or TAVI, the procedure approaches remain exactly the same.
  • What if my doctor is not aware of TAVR?
    We recommend asking your doctor to refer you to our Heart Team. The Heart Team doctors at Dr. L. H. Hiranandani Hospital are experts in valvular disease and valve replacement and are able to determine the best treatment option for you.
  • Do I need TAVR?
    Our Heart Team will review your case to understand whether you need TAVR. Your TAVR Heart Team may request you to get some of the procedures done again even though you may have done these before.
  • How do I know if I am an intermediate or greater-risk patient?

    There are several factors that determine whether or not you are at intermediate or greater risk for open heart surgery, and therefore, a possible candidate for TAVR.

    5 major factors include:

    1. Age
    2. Current health status
    3. Medical history
    4. Your frailty
    5. Condition of your heart
  • My doctor says I don't need TAVR. What should I do?
    If your doctor thinks you are not a good candidate, you may still contact our Heart Team at Dr. L. H. Hiranandani Hospital to receive a second opinion.
  • How much time will my procedure take?
    The procedure usually takes about 1-2 hours.
  • When can I be discharged?
    Your Heart Team will be able to assess and advise you on the same. However, under normal circumstances, patients are usually discharged in a couple of days.