TAVR(Transcatheter Aortic Valve Replacement )surgery for Aortic Stenosis

Q1 What is Aortic Valve?

A1. Aortic valve is one of the 4 heart valves that ensure smooth flow of the blood through the heart and out of it in one right direction. It is located between the left ventricle(lower left heart compartment)and Aorta. It ensures one way blood flow from the left ventricle to the largest artery in the body, Aorta. Aorta takes the oxygen rich blood from the heart to the whole body. At the time of ventricular contraction during each heart beat, 3 cusps or flaps of tissue that forms the aortic valve are flexible and open wide to allow oxygen rich blood to pass through it. When ventricle relaxes, the cusps of the Aortic valve close effectively to prevent flow of blood back into the left ventricle. 

Q2 What is Aortic Stenosis?

A2 Aortic stenosis is a medical condition in which the aortic valve becomes narrow or tight. Calcium may get deposited on the cusps of the valve making them stiff and thick and rendering them ineffective(Calcific Aortic stenosis). The cusps of the valve, under such circumstances, do not open wide, making the valve opening narrow resulting in restricted blood flow across the valve from the left ventricle to the aorta.

Q3 How is TAVR surgery done?

A3 TAVR is Transcatheter Aortic Valve Replacement procedure. It is recommended for patients with severe Aortic Stenosis who are advised against conventional open heart surgery due to high risk involved with the surgery or are simply too weak and sick to go for it.

During this procedure:

1. A tiny incision is made in the groin

2. Through this incision, a flexible tube(Introducer sheath)is placed into the femoral artery(a blood vessel in the thigh which is main source for providing oxygen rich blood to the lower limb) to provide access point for passing other surgical tools through it. 

3. Guide wire is inserted through Introducer sheath as mentioned above and guided till the aortic valve and pushed through it into the left ventricle.

4. Now a balloon tipped catheter is inserted into the femoral artery with the help of the guide wire and guided till the aortic valve.

5. Once the catheter reaches the aortic valve, balloon at its tip is inflated in order to expand the narrowed valve and push the damaged valve leaflets to the side.

6. Balloon is then deflated and catheter is removed.

7. Another catheter with the replacement valve placed at its tip is inserted into the femoral artery. This replacement valve is a tissue valve with a wire mesh called stent around it.The replacement valve is compressed and then placed.

8. Once this catheter with replacement valve at its tip reaches the aortic valve,the balloon beneath the stent is inflated and the stent with the tissue valve is positioned effectively. The stent helps to fix tissue valve in place and provides stability.

9. Subsequently, the balloon will be deflated and catheter and guidewire would be taken out.

10. Once all the surgical instruments are removed the insion is closed with stitches. 

11. Likewise another incision, that was made in the other groin to insert instruments in order to monitor the heart, is closed too.

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TAVR procedure is also sometimes referred to as TAVI (Transcatheter Aortic valve Implantation) since in this procedure old, damaged aortic valve is not removed, instead it is pushed to the side and the new replacement valve is positioned there. Normal blood flow can now be ensured through the new aortic valve.

Q4 What is the difference between Bioprosthetic valve and Mechanical valve?

A4 The replacement valve may be one of of the following:

1. Mechanical

• Artificially manufactured

• Made up of metallic alloy

• Lasts forever

• The patient needs to be on the blood thinning medication(Anti coagulants) for the rest of his/her life.

• Likelihood of its failure is extremely less.

• Lifestyle after surgery has to be adjusted to a large extent to accomodate for the usage of blood thinning medication.

​2. Bioprosthetic

• Taken from human or animal(generally pig) tissue

• No requrement for blood thinning medication.

• Can last for 10 to 15 yrs.

• May fail,after all it is a biological tissue.

• Life style is simple with minimal changes post surgery

Benefits of Transcatheter Aortic Valve Replacement (TAVR) surgery In India

• High quality treatment at the most affordable cost.

• High success rate with outstanding results 

• World class hospitals with state of the art infrastructure.

• No waiting period

• Globally trained and highly experienced Cardiac surgeons in carrying out the procedure with competence and ease.

• Great ambience

• Compassionate staff to look after

• Hospitals accredited with international organizations such as JCI(Joint commission International) for quality standards.

• Language no barrier. English speaking people and if required, translators are available for your convenience

• Most economical accommodation available at a walking distance from the hospital. Wide range of options starting from guest house, service apartments to five star hotels, best suited to your budget and choice.

• Good flight connectivity

• India has a diverse and rich cultural heritage. You can witness its beauty and uniqueness. It offers most conducive environment for recuperation.

Dr Naresh Trehan
MBBS, Diplomat(American Board of Cardiac Surgery),Diplomat(ABS)
Chairman and Managing Director,Heart Institute, Division of Cardiothoracic and Vascular Surgery)
Medanta,The Medicity,Gurgaon, Delhi-NCR