Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter aortic valve replacement (TAVR)

TAVR is a minimally invasive percutaneous procedure that replaces the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve site. Usually, valve replacement requires an open heart procedure with a “sternotomy”, in which the chest is surgically opened for the procedure. In this procedure, a catheter is placed in the femoral artery (in the groin) similar to angioplasty, and guided into the chambers of the heart.

A compressed tissue heart valve is placed on the catheter and is positioned directly inside the diseased aortic valve. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

TAVR

What?

Transcatheter aortic valve replacement (TAVR) or Transcatheter aortic valve implantation (TAVI) is a minimally invasive heart valve replacement procedure that repairs the narrowed aortic valve without major surgery.

How?

General or local anesthesia is given based on the patient’s condition.
A catheter (small tube) with a balloon at its tip is inserted into an artery usually through the groin.
The catheter is passed through the blood vessels guided by fluoroscopy (X-rays) into your heart and positioned within the narrowed aortic valve.
Then the balloon is gently inflated to make room for the new tissue valve.
The new valve is now inserted through the groin blood vessel and gently taken to the heart and placed at the narrowed aortic valve.
New valve expands either by itself or is expanded using the balloon, depending on the type of valve which is used.
The balloon is deflated and then the catheter is removed.
The new valve gets seated within the old damaged valve and is tightly held by the calcium which is usually present over the aortic valve.
After confirmation of valve function, groin blood vessels closed using a percutaneous suture.

Whom?

For patients who have been deemed intermediate or high risk for traditional open-heart surgery, transcatheter aortic valve replacement (TAVR) would be the best treatment option. Patients with low risk for surgery also can be offered this therapy particularly when they have other comorbid conditions. TAVR can be ideal for patients with a prior history of stroke, chest radiation, open-heart surgery, COPD, frailty, renal insufficiency, advanced age, and other conditions.

Who does it?

Dr. Gaurav Ganeshwala is one of the earliest to start the structural program in India and performed the first TAVR procedure in 2017 at Ruby Hall Clinic, Pune.

This is the first center in Pune, India approved to perform all the best in class TAVR systems in the world – the Medtronic self-expanding Core and Evolut R system and the Edwards balloon-expandable Sapien 3 system. Recently have also started Evolut PRO and the Indian Myval system with good results. The team consisting of interventional cardiologists, imaging specialists, heart surgeons, and cardiac anesthesiologists is headed by Dr. Gaurav Ganeshwala and Team MSH is highly experienced in all the valve types and performs all types of complex cases.