A 76-year old patient Bikash Dutta (name changed on request), from North East Region, Digboi, Assam, with past history of heavy smoking, was admitted with shortness of breath on exertion and chest pain in a city-based Medica Super-specialty Hospital.
Echocardiogram revealed severe obstruction of the main valve of his heart, aortic valve. With all his comorbidities, like lung disease, advanced age, Dutta, belonged to intermediate to the high-risk category for open heart surgery for replacement of the heart valve. At the same time, he was not at all ready to undergo heart valve surgery under general anaesthesia with a cut open of his chest wall.
An alternative option in such a situation was valve replacement through a small puncture in his groin artery and taking the valve with the help of a catheter. This is a new procedure which has been established in such patients yielding good results. It is known as TAVR. Patients who are scared of open heart surgery for aortic valve operation may choose TAVR. The patient and his family consulted the Medica Heart team doctors comprising Interventional Cardiologists, Anaesthetists and Cardiac Surgeons.
Dr Dilip Kumar, Consultant Interventional Cardiologist, Prof (Dr) Rabin Chakraborty, Senior Vice-Chairman, Cardiology Services, Cardiac Surgeon Dr Kunal Sarkar, Senior Vice-Chairman, Medica Super-specialty Hospital met the patient together and on clinical evaluation; suggested a TAVR procedure considering all the aspects. The entire procedure was very clearly explained to the patient and his relatives. The highly skilled and experienced heart team Medica Hospital was confident to perform this procedure.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure which repairs the valve without removing the old, damaged valve. The surgery may also be called Transcatheter aortic valve implantation (TAVI).
"Upon admission, he complained of shortness of breath and palpitation," said the team of doctors. TAVR was carried out on April 4. The access to the procedure was done through femoral puncture under the protection of the Proglide system which takes care of the puncture site after the procedure is over. "The entire valve system was taken over a stiff wire from the femoral artery to the Left Ventricle," said the doctors.
The Interventional Cardiology team and the surgical team took around an hour to complete the procedure. The patient was not under general anaesthesia and there was no requirement of blood transfusion. The patient recovered immediately after the procedure and became ambulatory within 48 hours. He was discharged on April 8, a hospital release said here today.
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The patient was seen after a month on a follow-up visit. He is doing well and leading a normal life. There was no complication during TAVR procedure, while he was in the hospital and on follow up visits, the doctors added.
Usually, valve replacement requires an open heart procedure with a sternotomy in which the chest is surgically opened. The TAVR procedure can be done through a very small puncture at the groin. Patients can be discharged in 48 hours after the procedure and resume his normal routine. "This case was not technically challenging but it required a lot of planning and involvement of a multi-disciplinary team," said Dr Dilip Kumar.
Management of this type of heart issue is generally done by surgical correction, open heart surgery. But non-surgical intervention is being practised as a safe alternative in India in the last two years, too. "TAVR can be an effective option to improve quality of life in patients who otherwise have limited choice to repair their aortic valve," explained Dr Chakraborty.
Risks of open heart surgery like prolonged general anaesthesia, ventilator, long ICU stay, the infection can be significantly minimised in TAVR patients mentioned Dr Chakraborty.
"Keeping in mind the patient-centred treatment plans, we recommended TAVR to treat the structural heart disease, which is not so uncommon. There are many patients of heart valve diseases who are otherwise unfit for open heart surgery, general anaesthesia", said Dr Sarkar.
"Today with a good skilled interventional cardiologists team TAVR is definitely a suitable option. Heart care is definitely in the midst of a transformation," added Dr Sarkar.
The doctors came to the consensus on the line of treatment, ensuring a rational approach with evidence-based medicine for better outcomes.
"Skill, efficiency and meticulous planning were the pillars of this case. We are happy to have cured a person who had come to us all the way from Assam within such a short time. Such cases are done in the East certainly puts the healthcare system in this part of the country on the forefront," said Dr Alok Roy, Chairman, Medica Group of Hospitals.
"The doctors in Assam referred baba to Medica. We are happy to see baba smiling once again. We are thankful to Medica doctors for being with us all throughout," concluded the younger son, who is a tea estate manager in Assam.
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