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TAVI: Transcatheter Aortic Valve Implantation

What is aortic valve?

There are four major valves in our heart. The valve which stops pumped blood from left ventricle returning back is named as aortic valve and when this valve is disease then it is called as aortic valve disease. Normally this valve is tricuspid but some people from birth may have bicuspid. Bicuspid aortic valve gets diseased earlier than tricuspid valve.

What are the diseases of aortic valve?

The aortic valve can either leak (aortic regurgitation) or get stenosed (aortic stenosis). Diseases due to bicuspid valve occurs earlier. It can also get diseased due to infection in childhood. Aortic stenosis is a disease of old age and occurs due to valve degeneration which is mostly because of calcium deposit.

How is aortic valve disease treated?

Traditionally, aortic valve disease was treated with open heart surgery but since most aortic stenosis is a disease of old age many people don’t get the benefit of surgery. For those patient who are high risk for surgery now transcatheter aortic valve implantation (TAVI) is a very good option.

TAVI

What is TAVI? TAVI is the most recent method of treating patients with aortic stenosis. Aortic valve is changed without opening the chest through key hole surgery done though the artery of the leg just like angioplasty is done.

Can TAVI be done in previously surgically replaced valve? Previously surgically replaced valve could either be metallic valve or tissue valve. If the previous valve is a tissue valve then TAVI can be done.

What is TAVI valve made of? TAVI valve is a biological tissue valve.

Will the patient be put on heart lung machine? No the patient is not put on heart lung machine.

Will general anaesthesia be given to the patient? 95% of the time general anaesthesia will not be given to the patient.

How many days will the patient be in the hospital? Immediately post TAVI patient is shifted to ICU. Next day the patient is assessed and if everything is good, the patient is made to walk and observed and if everything is good he/she is shifted to room. The patient is observed for one more day and then can go home.

What are the complications during the procedure? 5-10% of the patient may require permanent pacemaker, 1-2% patient may develop stroke. There can be bleeding from the groin from the catheter is introduced. Rarely aorta can rupture and death can occur.

Will my activity be restricted post TAVI? TAVI is done to treat and improve your condition. In no way your activity will be restricted or delayed. You will be able to do all your activity right after your discharge and will feel much better.

Mitraclip

What is mitral valve disease? It is one of the valve among the four major valves in the heart that stops back flow of blood from left atrium to left ventricle. The disease of mitral valve is called as mitral valve disease. If the valve leaks then it is called as mitral regurgitation and if it becomes stenosed then it is called as mitral stenosis.

What is the treatment of mitral stenosis? In young patients, where there is no calcium deposit on the valve and the left atrial appendage is free of clot balloon dilation of the valve called balloon mitral valvotomy (BMV) can be done. If the patient has calcium deposit on the valve and the left atrial appendage has clot then mitral valve replacement surgery is recommended. Mitral valve replacement can be done either with metallic mechanical valve or with tissue bio prosthetic valve. Your doctor will advise the best that you require.

What is the treatment of mitral regurgitation? Mitral regurgitation can be post infection either in early or late age. It can also functional which if due to structural abnormality in valve apparatus. If it severe rheumatic MR then surgical open heart mitral valve replacement is the treatment of choice. However, if it is functional then mitraclip can be done.

Who are the ideal patients? Patients who have functional MR and the valve is suitable for mitraclip for mitraclip by TEE and 3D ECHO; and is in heart failure despite optimal medical therapy and refused for open heart surgery due to other co-morbidities are the ideal patients.

How is mitraclip done? Mitraclip is done under general anaesthesia. The chest is not open and the procedure is doen through the groin. Most patients will require single clip, however, some patients may require two clips. Post procedure the patent is shifted to ICU and recovery monitored.

Will my heart failure symptoms improve after mitraclip? Mitraclip is done to improve symptoms of the patients. After discharge most of the patients feel much better and are able to continue their day to day activity.

Is mitraclip a safe procedure? This procedure is done at centre of excellence by doctor who is an expert in this procedure. However, one should keep in mind as with any other procedures this procedure also carries some risk.

TMVR

What is TMVR? This procedure is done for patients who have dysfunctional tissue bio prosthesis mitral valve replacement and is symptomatic with heart failure despite optimal medical therapy. It is done thought he groin and generally the patient is discharged in a day or two. This procedure carries lesser risk than surgery and recovery is also faster.

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About Eternal Hospital

Eternal Hospital (A unit of Eternal Heart Care Centre and Research Institute) is a state-of-the-art tertiary care hospital in Jaipur city. This landmark Healthcare Institute is the result of the vision of Dr. Samin K. Sharma, world-renowned Interventional Cardiologist based at Mount Sinai Hospital, New York, USA. Founded in 2013, today it is one of the most preferred hospitals not only in Jaipur but also nationally and internationally owing to the exclusive services and excellent medical outcomes delivered. Eternal Hospital brings the best in multispecialty treatment to the state of Rajasthan. Hospital with a capacity of 250 bedded hospital has state-of-the-art technology focusing on the specialities like Cardiology, Cardiac Surgery, Neurology, Neuro Surgery, Orthopaedic & Joint Replacement, Spine Surgery, Nephrology, Paediatrics, Gynaecology, Critical Care, Urology, Pulmonology, Gastroenterology, Diabetes and Endocrinology and many more.