TAVR is an effective treatment option for Aortic Stenosis patients with comorbidities: Dr. Madhuri Nagori
TAVR has proven to be an effective treatment option for Aortic Stenosis in Patients with Type 2 Diabetes, Hypertension, and Chronic Kidney Disease.
Aortic stenosis (AS) is a progressive heart valve disease that restricts blood flow from the heart to the rest of the body due to the narrowing of the aortic valve opening, increasing the risk of heart failure and death. The early symptoms of this disease are observed in older adults of age 65 and above.
Aortic Stenosis
Aortic stenosis is a degenerative age-related disease, commonly known as the silent killer as this disease manifests over years without any visible symptoms or cardiac complications. As the heart valve becomes narrowed due to the accumulation of plaque deposited over the years, the heart tends to work harder to pump blood through the narrowed opening. The common symptoms associated with this disease are chest pain, shortness of breath, fatigue, and fainting spells. Once detected, Aortic Stenosis requires immediate medical attention to avoid fatality.
Treatment Challenges in Patients with Comorbidities:
Treatment of Aortic Stenosis is highly complicated in patients with co-morbidities. Patients suffering from Type 2 diabetes, Hypertension, Chronic Kidney Disease, and other cardiac complications present unique challenges in management as they are more prone to the risk of complications during surgery and recovery. “In certain cases, patients with Chronic Kidney Disease are at higher risk of developing contrast-induced nephropathy following cardiac procedures, while those suffering from diabetes may have impaired wound healing and increased infection risk. Patients with Hypertension can be at an increased risk of developing cardiovascular events” informs Dr. Madhuri Nagori, Interventional Cardiologist, Bansal Hospital, Bhopal.
SAVR v/s TAVR:
Traditionally, a Surgical Aortic Valve Replacement (SAVR) also known as Open Heart Surgery was the only treatment option, and it was considered a high-risk procedure for patients with co-morbidities. Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive procedure has proven to be the most effective alternate treatment option for replacing the damaged aortic valve and has proven to be a safe option for patients with co-morbidities and cardiac complications. TAVR has a success rate of over 95% globally.
The TAVR Procedure:
The TAVR procedure is carried out in a CATH Lab with the patient put under local anaesthesia and mild sedation. Using advanced imaging techniques, the new metal or bio-prosthetic valve is inserted through the femoral artery in the groin using a catheter. The old damaged valve is replaced by the new valve and this new valve starts to regulate the normal flow of blood from the heart to the rest of the body immediately, functioning as efficiently as the previous organic valve.
TAVR avoids the need for open-heart surgery and is associated with shorter recovery times and fewer complications, making it an attractive option for high-risk patients.
Benefits of TAVR:
Compared to SAVR, the TAVR procedure has proven to be more efficient for patients during and post-surgery:
Minimally Invasive: As TAVR needs a small incision for the entire procedure, there is less trauma to the body compared to an open-heart surgery.
Recovery Time: TAVR patients need shorter hospital stays of about 4 to 5 days and have a quicker recovery time compared to the SAVR procedure.
Risk of Complications: TAVR procedures have been observed to have lower rates of post-surgery complications like stroke, infection, and bleeding.
Quality of Life: Patients usually return to their daily routine and activities about a few weeks after the procedure.
Case Study of Patients with Comorbidities:
Mr. Kumar (name changed to protect identity), a 68-year-old male was admitted to Bansal Hospital in Bhopal with symptoms of chest pain and breathlessness. The patient had a history of hypertension, high blood sugar, Chronic Kidney Disease and was on dialysis. In addition to these complications, the patient had previously undergone a Percutaneous Transluminal Coronary Angioplasty (PTCA) for Left Anterior Descending Artery (LAD) stenosis. His Echocardiography confirmed severe Aortic Stenosis and he needed immediate medical intervention to avoid further stress on his heart and to avoid any fatality.
Due to his medical history, he was considered a high-risk candidate for an open-heart surgery.
Under the expert guidance and advice of Dr. Madhuri Nagori, TAVR was prescribed as the only treatment solution to avoid any complications during and post-surgery for the patient.
“An aggressive approach to control the patient’s hypertension, glycaemic levels, and renal function was undertaken as pre-TAVR management to avoid any complications during and post-surgery. The TAVR was performed using a transfemoral approach, and we were keenly monitoring every progress due to his multiple medical conditions. The TAVR procedure using the Myval was successful and we are happy to report that there is post-procedural improvement in symptoms and his echocardiographic parameters” informed Dr. Nagori “This case highlights the complexities of managing AS in patients with multiple comorbidities and how TAVR has emerged as a valuable treatment option in such high-risk patients”.
