Apollo Hospitals, Guwahati has successfully performed Assam’s first ever Transcatheter Aortic Valve Replacement (TAVR) on a 73-year-old female patient.

TAVR or Transcatheter Aortic Valve Replacement, a percutaneous procedure, was successfully carried out on a 73-years-old female patient at Apollo Hospitals, Guwahati. The patient presented with breathing difficulties, chest pain on exertion and easy fatigability, and was admitted at Apollo Hospitals Guwahati, where she was diagnosed with a critical condition of severe calcific stenosis of the aortic valve. The only alternative was a valve replacement that had to be carried out immediately. Open-heart valve replacement surgery was not an option due to age and co-existing health issues.

The patient was offered the advanced option of TAVR or Transcatheter Aortic Valve Replacement (TAVR), an advanced percutaneous technique that allows intervention on patients who are unsuitable or are at intermediate to high risk for open-heart surgery. The advanced procedure was successfully performed on 1st September 2021. The patient recovered well without any significant peri procedural event and discharged in the next few days in a healthy condition.

Dr. Rituparna Baruah, Senior Consultant, Interventional Cardiologist at Apollo Hospitals, Guwahati said, “Patients with calcification of the leaflets of the heart valve, that open and close with the flow of blood, often present with symptoms only after the age of 70-75 years. However, if not treated, survival is difficult. TAVR is a revolutionary technique and a blessing for such patients so that they can have a prolonged healthy lifestyle with improved quality of life. Whereas in conventional open heart surgery, the chest cavity needs to be opened by cutting through the sternum to allow the surgeon to operate on the heart, TAVR is a percutaneous technique where it is accessed via needle-puncture of the skin, rather than a scalpel.”

In TAVR, an artificial aortic valve is inserted through a catheter, a thin flexible tube, from the groin into a blood vessel, under local anaesthesia. The deployed valve reaches the base of the aorta at the site of the aortic valve. The doctor then opens a balloon that inflates the valve pushing aside the old valve and overcoming the stenosis or narrowing. Using Monitored Anaesthesia Care (MAC anaesthesia), the patient remains aware but relaxed throughout the procedure that takes about an hour as compared to 5-6 hours required for an open-heart surgery. There is no need of General Anesthesia and a midline sternal incision, which is required in open heart surgery is not done in TAVR, thereby reducing prolonged hospitalization, and instead of a week’s stay, a patient who has undergone TAVR goes back home walking on the third day. The other benefits of TAVR include reduced and negligible need for blood transfusions, and reduced stroke risk of less than 1% as against 5-7% in conventional open-heart surgery.

Dr. D J Dutta, Senior Consultant Interventional Cardiologist at Apollo Hospitals, Guwahati said, “We are proud of having pulled off this feat at a time when the nation is fighting against COVID pandemic. Reports suggest over 5 lakh elective surgeries were postponed across the country. However, in this case, we couldn’t afford to wait for long, as any delay could have worsened the patient’s condition and could have been fatal.”

Dr. Rondeep K N Sivam, Consultant Interventional Cardiologist at Apollo Hospitals, Guwahati who assisted in this procedure said “This is the first case of its kind in the state of Assam. Having access of such advanced technology will largely benefit the people of Assam and neighboring areas.”

Dr. J P Kalita, Chief Cardiac Surgeon at Apollo Hospitals, Guwahati said “Transcatheter Aortic Valve Implantation (TAVI) or Replacement (TAVR) is approved for intermediate to severe risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR).”