Apollo Hospitals, Indore successfully performs Transcatheter Aortic Valve Replacement surgery on a nonagenarian patient.

TAVR or Transcatheter Aortic Valve Replacement, a minimally invasive surgical procedure, was successfully performed on a 93-year-old patient at Apollo Hospitals, Indore despite numerous challenges due to the lockdown. The nonagenarian with severe breathlessness and inability to lie down was airlifted to Indore, where he was diagnosed with a critical condition of severe 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 including history of bypass surgery, angioplasty, and renal dysfunction.

The patient was offered the advanced option of TAVR or Transformative Transcatheter Aortic Valve Replacement (TAVR), an advanced minimally invasive technique that allows surgery on patients who are considered as unsuitable or high-risk for open-heart surgery. The advanced procedure was successfully performed on 17th June 2020. The patient recovered well and was out of bed in just 4 hours after surgery, ready to be discharged the next day.

Dr. K Roshan Rao, Senior Consultant Interventional Cardiologist, Apollo Hospitals, Indore 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. At this age, a majority are not suitable for open-heart surgery. 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 minimally invasive surgical technique where inner organs are accessed via needle-puncture of the skin, rather than a scalpel.”

In TAVR, a miniaturized 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 MAC anaesthesia or monitored anaesthesia care, the patient is 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 anaesthesia, a midline sternal incision, which was required in open heart surgery, 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. Sarita Yadav Rao, Senior Consultant Interventional Cardiologist, Apollo Hospitals, Indore said, “We are proud of having pulled off this feat at a time when the nation was in a lockdown to fight the COVID pandemic. Reports suggest over 5 lakh elective surgeries were postponed across the country. However, in this case, we could not afford to wait for the lockdown to end, as any delay could have worsened the patient’s condition and could have been fatal. The team of doctors included the medical and surgical teams and also experts in infection prevention and control to ensure that all measures for the safety of the patient were taken, and the procedure took place with precautions including the highest Standards of Excellence in Infection Control Protocols and Best Practices. It was a testament to the efforts of the entire team that the procedure was performed with 100% success.”

The other members of the team at Apollo Hospitals, Indore included Dr. Shirish Agarwal, Jr. Consultant/ Associate Consultant Cardiologist, Dr. Vikas Gupta, Senior Consultant, Anaesthesia and Dr. Kshitij Dubey, Senior Consultant, CTVS.

Dr. Hari Prasad, President, Apollo Hospitals said, “TAVR and other advanced procedures are all set to change the face of cardiac care in India. The benefits when compared to conventional open heart surgery are incomparable. These advanced minimally invasive procedures allow us give a second lease of life to many patients who were previously classified as too high risk or inoperable. Apollo Hospitals is constantly striving to bring the latest advanced therapies for patients in India. Our trained experts with years of experience in cardiac care use scientific evidence based approaches, precision techniques, cutting-edge devices and medical equipment to overcome any medical challenges. On the anvil are newer structural interventions including Mitral clip, trans-catheter mitral, tricuspid and pulmonary interventions which would allow many patients who cannot undergo surgery, to benefit from minimally invasive therapies, giving them new hope and an improved quality of life.”

He added, “That this procedure was carried out during the COVID-19 pandemic is testament to our teams’
commitment to deliver world-class healthcare in the face of any and all challenges. We are proud that even amidst the COVID pandemic and lockout, we have continued to deliver lifesaving healthcare with proper precautions and protocols in place.”