• March 31, 2022
• By admin

Transcatheter aortic valve replacement: A minimally invasive, low risk and yet highly effective option to open heart surgery

With more than half of the population under the age of 25, India is generally considered to be a young country. However, it is predicted that the number of senior citizens will more than triple in the next three decades, with 434 million people falling into the category of the “oldest old” (aged 80 and more). As we grow older, the wear and tear on the heart’s various valves only gets worse, which leads to several complications.  Aortic stenosis is one such condition in which the aortic valve narrows, restricting blood flow to the heart.  Age-related scarring and calcium build-up in the valve cusp, which is a flap that opens to allow blood to flow through the valve, are the most common causes of this condition. Aortic stenosis is diagnosed in over a million people in India each year.  One in every eight people over the age of 75 is expected to be affected by this disease. Furthermore, it has a higher mortality rate than most cancers, with patients dying at a rate of 90 percent in four years if they are not treated immediately after being diagnosed. Open-heart surgery to replace the damaged valve has traditionally been the gold standard of treatment for aortic stenosis, but this procedure is considered too risky for many of the patients to undergo.(1)

This is the reason why Several recent observational studies, including one published in The Lancet(2), suggest that when treating patients at intermediate risk of surgical mortality, minimally invasive procedures such as aortic stenting may be preferable to open-heart surgery in some cases. Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that can be performed while the patient’s heart is beating. A thin tube is used to introduce a revolutionary collapsible replacement valve made of metal mesh and animal tissue into the heart (catheter). This procedure can be used as an alternative to open-heart surgery in some cases. It also eliminates the need for the administration of “blood thinners.” They are instead delivered via catheter, which is inserted in the femoral artery, followed by an expansion in place.

Treatment with transcatheter aortic valve replacement has been successful in a wide range of cases, including 90-year-olds with severely damaged valves, 2-leaflet aortic valves, and previously surgically replaced aortic valves that have failed. Previous research has demonstrated that TAVR is both safe and effective in patients who are at high risk of developing a heart attack. This method was investigated in the new study for patients who were considered to be at intermediate risk. Aortic valve replacement with a third-generation transcatheter valve appeared to be superior to standard aortic valve replacement in patients with aortic stenosis who were judged to be at an intermediate risk of surgical mortality, according to the findings of the study cited above. TAVR was performed at 51 sites across North America, and the researchers compared the outcomes of 1,077 intermediate-risk patients who received the procedure to those of patients who underwent open-heart surgery for surgical valve replacement. TAVR patients had better outcomes a year after surgery, including higher rates of survival, lower rates of stroke, and lower rates of re-intervention, according to the study findings.(2)

TAVR patients had better outcomes a year after surgery, including higher rates of survival, lower rates of stroke, and lower rates of re-intervention, according to the study findings.

Even patients who are at lower risk now have another treatment option that appears to be just as effective as open-heart surgery.” In some areas, TAVR will be the preferred option over other options. A significant advantage of transcatheter aortic valve replacement (TAVR) is that the hospital stay is only three days, as opposed to five days for traditional open-heart surgery. In a future study, it is planned to examine the effectiveness of TAVR in low-risk patients.

Since its introduction, the technology of TAVR has witnessed significant expansion and appears to be on the verge of becoming a universally accepted indication. However, its widespread adoption in India has yet to be seen due to factors such as such as high costs, lack of awareness, inadequate reimbursement, a scarcity of indigenous valves and hardware. But, TAVR has now solidified its position as a critical treatment option for aortic valve disease, and with an ageing population, it is likely that TAVR will play a critical role in the future of cardiovascular health in India.

References:

1) Gupta, Puneet et al. “Current status of transcatheter aortic valve replacement in India.” Cardiovascular diagnosis and therapy vol. 10,1 (2020): 83-88. doi:10.21037/cdt.2019.05.04

2) Thourani VH, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet. 2016 May 28;387(10034):2218-25. doi: 10.1016/S0140-6736(16)30073-3