TAVR Procedure in Mumbai at Jaslok Hospital

Jaslok Hospital, Mumbai, provides transcatheter aortic valve replacement (TAVR) for patients with aortic valve disease. TAVR is a minimally invasive cardiac treatment. This page explains what TAVR is, how it is done, what happens afterwards, who may be considered for it, and what risks and limitations apply.

What is transcatheter aortic valve replacement (TAVR)?

TAVR is a medical procedure that replaces the aortic valve of the heart. It is a minimally invasive alternative to open heart surgery. The procedure is also known as transcatheter aortic valve implantation (TAVI). Replacement valves are made of pig or cow tissue in a metal frame.

The aortic valve is the last of the heart’s four valves that regulate blood flow. Through this valve, the heart pumps oxygen-rich blood to the aorta and the rest of the body.

What does TAVR treat?

TAVR is most often needed for aortic stenosis, in which the aortic valve becomes narrowed. Common causes include:

• Age-related wear and tear, especially over age 65, which can lead to calcium buildup or thickening of the valve.
• Other health conditions, such as rheumatic heart disease or bicuspid aortic valve, which can speed up the degeneration of the valve.

Some patients who need aortic valve replacement are considered high risk for open heart surgery because of the severity of the stenosis, their age or other medical conditions. For these patients, open heart surgery may carry a higher risk of complications.

How is the TAVR procedure done?

The procedure is most often done under local anaesthesia. Mild sedation may be given before it begins. The doctors insert the new TAVI valve through a small puncture in the groin. The valve is guided up to the heart and positioned across the old diseased valve. It is then opened in place of the old valve and takes over its function. The procedure typically takes about an hour or two from start to finish.

What tests are done before TAVR?

Before TAVR, patients usually have the following diagnostic tests:

1. Blood tests
2. Echocardiogram
3. Electrocardiogram (EKG)
4. Computed tomography (CT) scan

After these tests, the patient discusses with the cardiologists what to expect during and after the treatment. The type of anaesthesia is also discussed.

What happens after TAVR?

After the procedure, the patient is shifted to the intensive care unit for one day for monitoring. Patients can usually sit up in bed after 2–3 hours and have some refreshments. They are made to walk the same evening or the next morning. They are usually shifted to a room after one day and discharged about two days later. The patient is sent home on oral blood thinners to help prevent clots.

How does TAVR differ from open heart surgery?

• Incision: Open heart surgery usually involves larger incisions in the chest, and the surgeon may need to lift or open the rib cage. TAVR is done through a single small puncture, and no ribs or internal organs need to be moved.
• Recovery: Smaller incisions mean less tissue to heal. Recovery varies from patient to patient.
• Hospital stay: A stay of several days is typically required after heart surgery. After TAVR, the doctor may send the patient home in 2–3 days, depending on the severity of the case, the timing of the procedure and the patient’s general health.

Who may be considered for TAVR?

The doctors at Jaslok Hospital may recommend TAVR for patients who have:

• Severe aortic stenosis, with symptoms such as shortness of breath and chest pain.
• A failed surgical aortic biological tissue valve. Some patients who have had surgery in the past for aortic valve replacement may develop re-blockage or leakage in the new surgical valve.
• Medical conditions that increase the risk of open heart valve replacement surgery, such as lung, liver or kidney disease, or frailty.

TAVR is a treatment option for patients with severe aortic valve stenosis who are at high or intermediate risk for open cardiac surgery.

Who may not be suitable for TAVR?

TAVR is not suitable for everyone. Common reasons include:

• A space that is too small for the new valve to fit.
• Other heart valve problems, such as mitral regurgitation (leaky mitral valve).
• Severe kidney disease.

Risks and limitations

TAVR is a cardiac procedure and, like any such procedure, carries risks. Possible complications include bleeding or blood vessel injury at the puncture site, stroke, kidney injury, irregular heart rhythm or the need for a permanent pacemaker, and leakage around the new valve. In some cases, emergency open heart surgery may be needed. Blood thinners taken after the procedure can increase the risk of bleeding.

Whether TAVR is suitable depends on the patient’s anatomy, valve condition and other health conditions, and is assessed by the treating doctors. Outcomes vary from patient to patient, and a replacement valve needs regular follow-up with a cardiologist. Patients should discuss the risks, benefits and alternatives with their doctor before deciding on treatment.

FAQ’s

Q1. What is another name for TAVR?

TAVR is also known as transcatheter aortic valve implantation (TAVI).

Q2. What type of anaesthesia is used for TAVR?

The procedure is most often done under local anaesthesia. Mild sedation may be given.

Q3. How is the new valve inserted?

The new valve is inserted through a small puncture in the groin and guided up to the heart.

Q4. How long does the procedure take?

It typically takes about an hour or two from start to finish.

Q5. What are replacement valves made of?

Replacement valves are made of pig or cow tissue in a metal frame.

Q6. Why are blood thinners prescribed after TAVR?

Oral blood thinners are prescribed to help prevent clots.