In recent years, cardiovascular diseases (CVDs) including ischaemic heart disease and cerebrovascular events such as stroke are the leading causes of death globally. According to World Health Organization (WHO), India accounts for one-fifth of these deaths worldwide, especially in the younger population. Studies reveal that Aortic stenosis (AS) is the most common valvular heart disease and the third most common cardiovascular disease after hypertension and coronary artery disease in western countries. The condition occurs when the opening of the aortic valve becomes narrow leading to a reduction in the blood flow since the normal amount of blood cannot flow anymore due to the narrow valve.
When this occurs, the blood flow is restricted from the left ventricle to the aorta. This narrow valve can affect the pressure inside the left atrium. When this happens, the rest of your body is unable to get the blood that it requires because the aorta doesn’t receive it. This condition if not corrected on time can lead to various serious complications. With the advancement in research and technology, minimally invasive procedures are being introduced for such complicated diseases to improve patient care in a simpler and safer way.
One such procedure is Transcatheter Aortic Valve Replacement (TAVR) that has been proven to be a better option for patients of aortic stenosis as compared to open heart valve replacement surgery. Financial Express.com reached out to Dr. Atul Mathur, Executive Director – Interventional Cardiology & Chief of Cath Lab, Fortis Escorts Heart Institute, Okhla and he talked about the benefits of TAVR procedures, its scope in India among others. Excerpts:
What is the Transcatheter Aortic Valve Replacement (TAVR) procedure in India? Why and how is it performed?
Earlier severe aortic valve stenosis had to be treated by open heart valve replacement surgery. This new non surgical technique is done by transcatheter replacement of the aortic valve through a pin hole while the patient is awake. Next day ambulation and speedy discharge even for high risk patients.
What is the performance statistic of this procedure in India? What type of patients is eligible for this procedure?
India statistics not available but globally the safety is superior to open heart surgery in high and moderate risk patients and comparable to low surgical risk patients. The durability of these tissue valves is expected to be similar to surgical valves as seen in early trials. Patients above 60-65 years age having severe symptomatic aortic stenosis are candidates for this procedure provided the anatomy is suitable.
Currently, India has a large number of patients with aortic stenosis (AS) and despite the potential of TAVR, it is beyond the reach of an average person in the country. The first TAVR procedure of the country was performed in 2011. It’s been over a decade, yet the expansion has been slow in the country. What are the possible causes and how to make it more accessible? What are the main reasons and what needs to be done to overcome these challenges?
High Cost and skill training are current limitations in our country. Cost is fast coming down with increasing competition and growing volumes both working favourably.
What are some other alternative procedures to treat aortic stenosis (AS)? How effective are they as compared to TAVR?
Open heart surgery is the only other option for severe symptomatic aortic stenosis. Despite best medication patients go downhill rapidly in 1-3 years. Advanced age and multiple co morbid conditions make open heart surgery high to exorbitant risk. All such patients were considered untreatable earlier. As all therapies are moving towards minimal invasive options, structural heart interventions are evolving rapidly to provide simpler and safer alternatives to open heart surgery.