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Stents/TAVR/TAVI

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Studies show that heart disease is the leading cause of death worldwide. And, aortic stenosis is the most common valvular heart disease and the third most common cardiovascular disease after hypertension and coronary artery disease in the western world. It is also often referred to as a disease of the elderly however a lot of young adults have also been diagnosed with aortic stenosis. The disease can occur in a single valve or in a combination of the four valves.  Usually, aortic stenosis is most common in heart’s aortic valve and mainly occurs due to the buildup of calcium deposits that narrows the valve.  When it comes to the treatment for aortic stenosis, it completely depends on the severity of the patient’s condition. Suggesting a valve replacement surgery or advising patients with medication and lifestyle changes completely depends on the doctor. But, it is important to understand that no pill can cure aortic stenosis completely but there are few medications that may help in lowering down the risk and complications involved. Let us now look at the treatment choices available for treating aortic stenosis along with its cost in India.

Treatment of Aortic Stenosis

Aortic stenosis is a progressive disease, which means it will get worse with time. Due to this, aortic stenosis is measured as mild, moderate, or severe stages depending on how damaged your aortic valve is. Treatment options for aortic stenosis generally range from simple medications such as statins or surgical repair or replacement of the diseased aortic valve. No pill can cure aortic stenosis, but medication like statins can help you lower your cholesterol which can control your symptoms and lower the risk of heart attack and stroke for some time. However, anyone with aortic stenosis should be checked with an echocardiogram to determine treatment options. Although, medication may be appropriate only for a person for whom surgery is not an option or for someone who’s aortic valve condition is in a very mild stage without any major visible symptoms.

In most of the cases, aortic stenosis treatment requires surgical treatment to protect the heart from further damage. Generally, surgery for aortic stenosis treatment depends on each patient’s unique requirements and factors responsible for their condition. Two of such major surgical treatment options for aortic stenosis include aortic valve replacement and Balloon/surgical Aortic Valvuloplasty (BAV).

  • Aortic valve replacement: In this procedure, your diseased aortic valve will be replaced with the mechanical valves made of metal or with valve tissue from pigs, cows or human donors using traditional open-heart surgery or Transcatheter Aortic Valve Replacement (TAVR).  Undergoing a TAVR surgery is a better treatment option as it is a minimally invasive procedure involves placement of a new valve over the patient’s diseased valve via a catheter inserted through the femoral artery and hence result in quicker recovery post procedure enabling the patients to go back to their normal lives.
  • Balloon/surgical valvuplasty (BAV): It is a less invasive procedure because it is done by inserting a long flexible tube with a deflated balloon on its tip into the blood vessel from the groin. When the tip reaches the valve, the balloon is inflated which helps to open up the stenotic or stiffed heart valves and increase the blood flow through the heart.

Why consider India for aortic stenosis treatment?

According to doctors, aortic stenosis treatment in India can be obtained at highly economical rates as compared to the Western world. Due to low treatment cost and a high level of expertise for cardiac diseases including aortic stenosis, India has become a leading destination for medical tourism in the world. Generally, the treatment cost for aortic stenosis in India depends upon multiple factors such as the selected treatment procedure, used technology, the severity of the disease, location, pre- and post-operative care demanded and other selected services. However, irrespective of any procedure selected for aortic stenosis treatment such as a SAVR, TAVR or balloon valvuplasty, the cost is less than the hospitals in western countries. People visiting India for treatment are not only from neighbouring countries like Bangladesh, Afghanistan and Nepal but also from far off countries like Kenya, Nigeria, Iraq, Yemen, Kazakhstan, Iran, Uganda and Oman. In India, aortic stenosis treatment is preferably carried out at a number of well-renowned multi-specialty and super-specialty hospitals located across a number of metropolitan cities of India such as Mumbai, Delhi, Chennai, Hyderabad, Pune, etc. These hospitals offer world-class facilities and doctors who are well-versed in performing these surgeries, even in the most challenging situations.

According to global standards, the cost of aortic stenosis treatment in India ranges from a few thousand rupees a month. As per an estimate of 2016, the mean cost for TAVR procedure in the US were 69,592$ vs 58,332$ for SAVR. As compared to these estimates, TAVR cost in India is roughly half (34,900$) to that of the US hospitals. In simpler terms, the cost of TAVR surgery in India is estimated to be 18 to 20 lakhs which is 3 times lower versus any hospital in the western world.

These numbers along with the quality of treatment provided in India and effectiveness of TAVR are clearly responsible for a spike in the numbers of international patients. This means that the trend has clearly changed in the past decade in terms of treating a faulty valve and allowing individuals to live those additional years with greater quality of life or in an improved health state.

TAVR (Transcatheter Aortic Valve Replacement) is a fairly new therapy that has been developed in the last 15 years. It is a minimally invasive procedure invented to replace the diseased valves of the heart. Because of its high success rate and relatively less complicated nature as compared to the open heart approach, today TAVR therapy is at the top of the list when it comes to treating Aortic stenosis. From Europe to the United States to the Asian countries, TAVR therapy clearly is the preferred option for most of the surgeons in the new-age era. 

Earlier, more than 50 percent of patients were not recommended surgery due to various factors such as old age or other medical conditions. With TAVR entering the scenario, it has become easier for patients with complications to opt for better options. While TAVR comes with lower risk, it gives helpful treatment choices to individuals who might not have been otherwise considered for valve replacement. You are more likely to spend less time in the hospital after TAVR and it comes with fewer complications as compared to surgical valve replacement. 

If by any chance you have been lately identified with severe aortic stenosis then need not to panic. The best advice is to seek immediate medical care. The earlier you’ll pay medical attention, the quicker you’ll be able to get back to your normal life. Usually, your doctor determines the best possible way for replacing your faulty valve with a procedure that suits best for you. With TAVR, a small incision is made in the leg and hollow tube called a sheath is inserted into your femoral artery.

The thought of a heart valve replacement can be frightening. Fortunately, the less invasive TAVR is an option for more patients unlike earlier. Presently, only two Indian companies are making valves. TAVR is being performed in around 30 centers in India. Out of these centers, only 7 are considered to be the major ones. This is significantly less than the total number of cath labs present in India. The progress for TAVR in India remains rather slow with barriers at various levels. The probable reasons for such a lower number could be:

  • Reluctance among professionals.
  • High operative cost as compared to other procedures.
  • Regulatory approvals.
  • Lack of dedicated heart teams and specialized centers.
  • Lack of proficiency in TAVR.
  • Anatomical constraints amongst Indians not suited for the procedure.

As per the latest evidence, the average life expectancy post TAVR largely depends on the age factor of a patient. For example, for a 50-year-old patient, the average life expectancy is 31.5 years while it is just 4.6 years for a 90-year old patient. As per trials, the survival benefits are very limited when treating octogenarians (people between the age of 80-89 years) with TAVR. Also, co-morbid conditions of the patients such as diabetes or hypertension have a significant impact on the survival of patient after TAVR. More importantly, the quality of life in terms of activity and overall health receive a substantial boost after TAVR which is more beneficial in old age as compared to mere living.

As per an estimate of 2016, the cost for TAVR procedure in the US was 69,592$. As compared to these estimates, TAVR cost in India is roughly half (34,900$ i.e. Rs 26,11,387) to that of the US hospitals. In simpler terms, the cost of TAVR surgery in India is estimated to be 18 to 20 lakhs which is 3 times lower versus any hospital in the West. However, this cost is around six times higher vs. open-heart surgery. But, open-heart surgery is not suited for every patient. Particularly, for elderly patients with co-morbidities who are deemed to be at high surgical risk and form the major patient population. Hence, they need to undergo TAVR. At this moment, this procedure sets an extremely daunting task for the surgeons and the patient’s family to manage such a huge expenditure. Technical innovation in terms of device and procedural advancements coupled with the availability of indigenous device may ultimately aid in reducing the huge cost of this extremely useful treatment.

The choice to treat aortic stenosis with TAVR is made after you ask a group of heart surgery specialists, who cooperate to decide the best treatment option for you. Without a doubt, TAVR therapy is changing the trend and is already proving to alleviate the signs and side effects of aortic valve stenosis. With local manufacturers entering the space with top-notch products satisfying all the necessary standards, TAVR therapy seems to be the best possible option available for treating aortic stenosis even in India.

The heart is one of the most important organs in the human body. The function of the heart is to pump blood. The human heart has four chambers. Each chamber has its own valve to make sure blood flows in the right direction. The aortic valve is the last of the four valves that blood passes through before leaving the heart. The job of the aortic valve is to pump that oxygen-rich blood into the aorta, the largest blood vessel in your body.

The aortic valve has leaflets which open and closes during each heartbeat. In some heart diseases, the valve does not open or close properly disrupting the blood flow to the body. This may lead to the valve leaking and is called valvular regurgitation.

Another form of valve disease is valvular stenosis that commonly affects the aortic valve. This condition occurs due to calcium build-up on the leaflets leading to the stiffing of the valve. The severity of aortic stenosis increases with age and can be classified as mild, moderate, and severe. The stiffing of the valve prevents it from opening fully which reduces or blocks the blood flow from the heart to the rest of the body.

When the blood flow through the aortic valve is reduced or blocked, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump, and this can cause symptoms as well as possibly weaken your heart muscle.

Calcium build-up in the valve, heart defects at birth and rheumatic fever are some of the causes of aortic stenosis.

Some people with aortic valve stenosis may not experience any symptoms for many years.

Signs and symptoms of aortic valve stenosis may include:

  • ·Abnormal heart sound (heart murmur) heard through a stethoscope
  • ·Chest pain (angina) or tightness with activity
  • ·Feeling faint or dizzy or fainting with activity
  • ·Shortness of breath, especially when you have been active
  • ·Fatigue, especially during times of increased activity
  • ·Heart palpitations — sensations of a rapid, fluttering heartbeat
  • ·Not eating enough (mainly in children with aortic valve stenosis)
  • ·Not gaining enough weight (mainly in children with aortic valve stenosis)

If you have the above symptoms, don’t worry. Visit your doctor today.

An aorta is the largest artery in the human body supplying clean, oxygenated blood to the entire circulatory system. Aortic valve stenosis is a condition where the aorta of the heart gets blocked. The disease can be diagnosed by an experienced Cardiologist by clinical examination, studying the Echocardiogram (‘Echo’), CT angiogram and a few other tests.

1) Blood test

2) ECG

3) Echocardiogram

4) Heart Beat Monitoring

5) Stress Test

Medications can be prescribed to improve the heart’s ability to pump blood which may help compensate for a valve that isn’t working correctly.
However, a diseased heart valve is a mechanical problem that cannot be fixed with medication alone, and surgery is often needed to repair or replace the damaged valve.
Once it is determined that a diseased heart valve needs treatment, the available choices are valve repair or valve replacement.
To know more, visit your doctor today.

The word aortic stenosis may seem alien, but the condition is one of the most common valvular heart diseases in the world. Usually seen in the elderly, with symptoms surfacing mostly after the age of sixty, Aortic stenosis may also be a congenital condition. Our heart contains four valves, the mitral, tricuspid, pulmonary and the aortic. The former two control the flow of blood from one chamber to another while the pulmonary and aortic direct the blood away from the heart. The pulmonary artery directs the blood to the lungs and the aortic artery directs the blood to the rest of the body. In this condition, an aortic valve begins to show signs of stenosis or narrowing, thus reducing its operating capacity. This results in a reduced supply of oxygenated blood to the body which leads to symptoms like breathlessness, chest pain, fainting and palpitations. If the symptoms are mild or not present, the cardiologist may decide to simply monitor and follow up. However, if the stenosis has shown significant progress and has started to exhibit major symptoms, then the best option is to undergo Transcatheter Aortic Valve Replacement (TAVR).

TAVR is a minimally invasive surgery, as in, the chest bones are not opened up as in a bypass. It is instead a lot like a stent placement procedure. Small incisions are made in one’s groin to access the femoral artery and a hollow tube is placed in it. The new valve is placed on a tube with a balloon tip on one end and crimped to fit the hollow tube. The hollow tube is then inserted into the femoral artery and pushed through until it reaches the diseased valve. At this point, the balloon is inflated which in turn expands the new valve and helps it take its place. The new valve pushes the leaflets of the original valve to secure its place. Once the new valve is up and running, the balloon is deflated and removed.

Transcatheter Aortic Valve Replacement is relatively new. As a result, it is advised only for high and immediate risk patients by regulatory authorities and has shown promise in treating patients at low risk too. As shown by extensive research, heart valve replacement is a safe and suitable option for elderly patients, with recent studies demonstrating a 94% [1] [2] survival rate in 5 years. The survival rate for any individual patient also depends on other factors like their overall and cardiac health, co-morbid medical conditions and age. While early TAVR procedures demonstrated success rates of merely 70-80%, advanced cardiac care, surgical technologies and tools have increased the rates to as high as 92%. The overall procedure is also deemed to be nominally risky with a 2% chance of complications and fatalities across all age groups. This holds true even for elderly patients above 80.

The recovery process for Transcatheter Aortic Valve Replacement can take quite a few weeks. Most cardiologists recommend a course of blood thinners to prevent clots and antibiotics to prevent infection for their patient’s optimum recovery. Patients can expect to resume their normal activities gradually once they are totally recovered but will still have to undergo regular check-ups from their cardiologist. These check-ups are vital as they are meant to ensure that the patient’s heart and new valve are working properly.

When it comes to one’s heart, any risk is too big to take. For those whose lives have been restricted by aortic stenosis, Transcatheter Aortic Valve Replacement therapy provides an opportunity to lead a normal life with normal activities again. With experienced surgeons, advanced tools and techniques, this minimally invasive surgery is sure to change the lives of those who are suffering from the advanced stages of the disease.


Your heart has four valves that pumps the blood throughout the body. These four valves work relentlessly to ensure blood supply to all the organs in the body. But sometimes as time passes, the usual wear and tear sets in causing the main valve, called the aortic valve in the heart to be blocked.

Once blocked it becomes very difficult for the heart to pump the adequate amount of blood required by the body resulting in breathlessness, chest-pains and finally heart attacks.

To fix this condition, the patient needs to get a valve replacement surgery. Usually, valve replacements are done through open-heart surgery wherein a new tissue or mechanical prosthetic valve is inserted in the place of the diseased valve.

Open heart surgery is an invasive procedure with a very long recovery period. This can be a difficult challenge for patients, especially elderly patients.

But there is an alternate method to open heart surgery which is less invasive and has a shorter recovery period. It’s called a TAVI.

A TAVI or Transcatheter Aortic Valve Replacement (TAVR) technique is a life-saving treatment modality for patients who are unwilling or are high risk patients to undergo an open heart surgery.

This minimally invasive procedure involves placement of a new valve over the patient’s diseased valve via a catheter inserted through the femoral artery (large artery in groin).

This procedure can thus be done through small openings and hence result in quicker recovery post procedure enabling the patients to go back to their normal lives.

To know more about the procedure, visit your cardiologist today.