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Transcatheter Aortic Valve Implantation
- Days In Hospital 10 days
- Outside Hospital Stay 20 days
- Success Rate 66%
Minimum Cost
$ 28000
Maximum Cost.
$ 45000
Overview of Transcatheter Aortic Valve Implantation in India
Transcatheter Aortic Valve Replacement is a procedure in which smaller incisions are made to repair the damaged aortic valve and replace it with an implantable valve. The aortic valve is located in the heart and manages the blood flow going from the heart to the body. This procedure is also called Transcatheter Aortic Valve Replacement (TAVR).
Transcatheter aortic valve implantation takes place in individuals with severe aortic valve heart-to-body flow obstruction. When it is not possible to treat aortic valve dysfunction with medications and other therapies, then by use of transcatheter aortic valve implantation, the valve can then be replaced with an artificial implant. TAVI is usually completed for patients where open heart surgery would be too risky for the patient or has other significant terminal comorbidities that would complicate an open heart surgical approach.
TAVI carries the added benefit of the patient having shorter stays in practical spaces following the procedure, and TAVI has a lower risk of complication than open heart surgery does. Additionally, less recovery time is needed with patients with TAVI. TAVI has some risks that must be planned for in order to prevent a delay in the recovery process. TAVI does give patients an improved symptomology and quality of life.
What Is TAVI?
TAVI (transcatheter aortic valve implantation) is a minimally invasive, non-surgical method to replace a narrowed aortic valve with an artificial aortic valve via a transvascular approach without the need for surgery. TAVI involves placing an intravascular catheter through the groin (transfemoral) or heart apex (transapical) or aortic arch (transaortic) to aortic valve stenosis, and allows the artificial aortic valve to unfold from the delivery system and expand into a new aortic heart valve that would replace a stenotic aortic heart valve without surgery.
TAVI is an important option for elderly patients with severe aortic valve stenosis and are not candidates for open chest surgery because TAVI does not result in a surgical wound, thus reducing both surgical risks and complications, allows patients to recover more quickly, and will enable patients to live to the fullest.
Why Is Tavi Needed?
TAVI is a therapy for severe aortic stenosis which is a condition where the aortic valve becomes narrow and prevents blood from flowing out of the heart causing the heart to work much harder to pump blood out around the body.
TAVI is performed with the Edwards Sapien Transcatheter Heart Valve (THV)—an artificial heart valve designed to be placed in your heart to keep it open and replace your diseased aortic valve. It has a metal stent (made of steel or cobalt-chromium) that holds the device in place inside your own valve, and valve leaflets (made of biological material derived from cows) directs blood flow out of the heart.
TAVI now provides effective treatment for patients at high risk for traditional open heart surgery. It is also used to prevent further damage to the heart from aortic stenosis and to improve survival - something medical therapy cannot provide.
Types of Transcatheter Aortic Valve Implantation:
Transfemoral TAVI
This method entails placing the new aortic valve into the heart through a catheter inserted into the femoral artery in the groin (where the femoral artery is located). Transfemoral TAVI is the most common and preferred approach, when possible, because it is less invasive.
Transapical TAVI
This procedure involves placing the new valve into the heart through a small incision in the chest, typically on the left side between the ribs. In this method, the catheter is guided directly through the upper portion of the heart. This approach might be utilized if the transfemoral method is not appropriate.
Transaortic TAVI
In this type of TAVI, the new valve is implanted into the aorta through a small incision. This approach might be performed if the transfemoral or transapical approaches are not appropriate.
Transcaval TAVI
A newer method, transcaval TAVI, creates a temporary connection between the abdominal aorta and the inferior vena cava, which allows the catheter to deliver the valve via the abdomen. It can be used in select cases when other approaches cannot be used.
Trans-subclavian TAVI
Trans-subclavian TAVI describes a catheter placed through a small incision in the artery beneath the collarbone which access the aortic valve and is used when other approaches cannot be used.
Direct Aortic TAVI
In a direct aortic TAVI, a new valve is placed directly into the aorta via a small incision through the aortic wall. Direct aortic TAVI is performed only if the patient's overall clinical condition is good.
Procedure:
Below is a general overview of the process of transcatheter aortic valve implantation:
Anesthesia: The procedure is usually done with local anesthetic to minimize discomfort and pain.
Access: The appropriate access point is then cleaned and a small incision is made to enter with the catheter.
Catheter Insertion: A catheter with a compressed valve is inserted through the access point. The catheter is then advanced through the blood vessels to the aortic valve.
Positioning: Advanced imaging is used to position the catheter at the diseased aortic valve properly.
Deployment of the valve: After the catheter is positioned correctly, the new valve is deployed. In a balloon-expandable valve, the balloon is inflated, expanding the new valve and pushing away the diseased valve leaflets. The self-expanding valve expands as it is released from the catheter.
Catheter Removal: The catheter is removed, and the access port is usually closed with sutures.
Recovery: Unlike open-heart bypass surgery, TAVI has quicker recovery and reduces hospital stay.
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Cost of Transcatheter Aortic Valve Implantation in India
The typical TAVI/TAVR cost in India is INR 15,00,000 to INR 25,00,000 for Indian patients. For international patients, it is roughly USD 28,000 to USD 45,000. Of course, costs may vary depending on the type of TAVI procedure being done on patients. Costs may also vary depending on individual patient's condition at the time of surgery.
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Indications of Transcatheter Aortic Valve Implantation:
- Aortic stenosis with severe symptoms
- High risk of surgery
- Open heart surgery contraindications
- Comorbid elderly patients
- Individuals having a short life expectancy
- Individuals with aortic damage
- severe malfunction of the left ventricle
- Individuals who have had prior coronary artery bypass grafting (CABG)
- Stenosis in the bicuspid aortic valve
- Replace the valve again with a high surgical risk.
Risk Factors:
Surgical complications
In more serious cases, bleeding may occur either during or after surgery. There is also a risk of the patient being infected during the TAVI procedure.
Arrhythmia
There is a risk of arrhythmia in patients undergoing the TAVI procedure. Arrhythmia is a serious medical condition that must be addressed promptly.
Kidney injury
There is a risk of kidney injury during or immediately after the procedure.
Organ injury
There can be injury to organs from the catheter if the physician does not use sufficient care. This may worsen the patient's condition.
Death
In rare cases, there is a risk of death during or after the procedure, if the patient is not stable.
What Is The Benefit Of Tavi?
- No surgical operation, no scars, and no anesthesia.
- Minimal incisions, less pain, and decreased trauma to surrounding tissues.
- Minimal blood loss, no harm to internal organs.
- Minimal risk, minimal sequelae.
- Short procedure time (1-2 hours), less overall time in the hospital.
- Cost-effective, decreased length of stay.
- Short recovery time (3 months).
- Safe in elderly, frailty, comorbidities.
- Efficacy of treatment is similar to surgery.
- Improved quality of life.
- Improved life expectancy.