There are four valves in the heart and the aortic valve is located between the left vertical and the aorta, the largest artery in the body.
Aortic Stenosis is narrowing of the aortic valve opening. It can occur due to congenital heart defect, but it is very common due to old age, as calcium or scarring damages the valve and restricts blood flow through the valve.
This situation compels the heart to work harder to pump blood and this eventually weakens heart muscle. Left untreated, aortic valve stenosis can lead to life-threatening heart problems.
Typically, older patients cannot have conventional valve replacement surgery due to high risk, as assessed by the EURO and STS scores. However, now they have a new and minimally invasive option - the TAVR (Trans Catheter Aortic Valve Replacement). TAVR is a minimally invasive procedure that repairs the narrowed aortic valve without a major surgery.
Once a patient is suspected to have Aortic Stenosis, diagnosis is confirmed by echocardiography and operative risk assessed objectively by the EURO score II. Accordingly TAVR is decided, a 320 slice CT coronary angiogram and an aortogram up to the femoral vessels is done, to assess the anatomical feasibility of the blood vessels.
If suitable, the patient is admitted to hospital a day before the planned procedure and undergoes the procedure under local anesthesia.
A catheter is placed in the femoral artery (in the groin) and guided into the chambers of the heart .A compressed tissue heart valve is placed on the balloon catheter and is positioned directly inside the diseased aortic valve. A team of interventional cardiologists, imaging specialists, heart surgeons and cardiac anesthesiologists work together, utilizing fluoroscopy and echocardiography to guide the valve to the site of the patient’s diseased heart valve. Typically the patient can walk on the second day and can go home by day five.
What is the future of TAVR?
Till date, at least 10 different valves with improved design and delivery system are in the pipeline awaiting approval. The possibility of using TAVR for bicuspid aortic valve stenosis and primary aortic regurgitation is being explored.
TAVR has indeed been a boon to many elderly patients even over the age of 75 and has given them a second lease of life!