New Milestone in Heart Surgery
Less Invasive TAVR done under local anesthesia – simplified treatment for a senior citizen aged 79 with Severe Aortic Stenosis
Chennai, April 2018: TAVR – A Lifesaving Alternative for Open Heart Surgery now becomes simplified with next day discharge. The disease of Aortic Stenosis is on the rise in the ageing Indian population affecting close to one million elders every year. Fifty per cent of patients suffering from Aortic Stenosis can face sudden death, if not treated on time. The 79-year-old elderly patient was successfully treated under the TAVR system by Dr. G. Senguttavelu, senior cardiologist at Apollo Hospital Chennai. Dr. G. Sengottuvelu has explained about the TAVR treatment provided to the senior citizen at the press conference held today.
Dr G Sengottuvelu, India’s leading senior Interventional Cardiologist, Apollo Hospitals Chennai said “Patients with severe aortic stenosis often develop symptoms that can restrict normal day to day activities such as walking short distances and climbing stairs. These patients can often benefit by replacing their ailing valve but only approximately around two-thirds of the patients undergo procedure every year across the globe. The main reason is lack of awareness. Once symptoms appear, untreated patients have a poor prognosis. Without treatment, symptomatic aortic stenosis will eventually lead to death.”
Aortic Stenosis is a very common valvular heart disease and it can lead to significant mortality and morbidity in the elderly population. The prevalence of AS increases from, 2% in adults over 65 years of age to 4% in adults over 85 years of age. AS is a progressive condition and after the onset of heart failure, survival is less than 2 years without valve replacement. 50% of patients with AS presenting with angina, syncope or heart failure, survive for 5, 3 or 2 years respectively without aortic valve replacement (AVR). As life spans increase, the burden of senile AS on the health care system is expected to increase. Close monitoring and use of AVR when the disease becomes significant remains the standard of care. Transcatheter aortic valve replacement (TAVR) has seen worldwide adoption for the treatment of degenerative aortic stenosis (AS). Around 300,000 global implantations have been done.
Since the first implantation there is a rapid progress in the field of TAVR resulting in new devices, refinement of procedure techniques and decreased complications. TAVR initially started as treatment modality in surgically inoperable patients, but now expanded to high and intermediate risk patients as well. With further experience, refinements in hardware and technique, TAVR is now becoming a minimally invasive procedure with a good safety profile, rapid recovery and shorter hospital stay. Although TAVR in India started late, it is rapidly growing with expanding indications.
A very important feature of this TAVR procedure is that it has shown not only to improve the length of peoples’ lives but also the quality of life. TAVR is a great addition to our ability to care for patients with valvular heart disease, and for the appropriate patient, we’ve seen outstanding results”.
Dr G Sengottuvelu further said TAVR is done without cutting open the chest using catheter methods. Conventionally TAVR was done under general anesthesia, insertion of pulmonary artery (PA) catheter for monitoring, three arterial lines, and vascular cut down for primary arterial access and with a hospital stay of 5-7 days. World over, due to improvements in hardware, physician training and experience TAVR is done using less invasive approach. Today after gaining lots of experience we have also started with very minimal intervention to the patient and share our initial reports from our country.
Though TAVR is a minimally invasive procedure which is purely percutaneous, several new advanced technique in TAVR has been evolved which reduces post TAVR complication and benefit the patient. The concept of less invasive TAVR includes local anesthesia instead of general anesthesia, minimizing the need for extra arterial lines shorter duration of hospital stay and closure of arterial puncture site without vascular cut down surgery. Pre procedure assessment included echocardiogram to assess the severity of aortic valve disease, left ventricular function, coronary angiogram and CT scan for assessing the aortic valve measurements and femoral artery size measurement. Risk assessment was done using STS score which predict the risk of Surgical AVR.
Heart team meeting will be held which involves discussion with various specialists such as cardiologists, cardiac surgeons and cardiac anesthetist. Access were obtained through femoral artery and were closed soon after the procedure by using sutures without vascular cut down surgery. This helped the patient for early movement and early discharge. Patient required no additional artery puncture other than femoral artery puncture and arterial pressure monitor puncture. Patient observed for 24 hours after procedure for brain damage, bleeding, heart electrical changes and was discharged safely the next day of procedure with satisfactory valve parameters. Patients say they feel much better and are able to breathe comfortably after TAVR Procedure