It was like a rebirth for 93-year-old freedom fighter who underwent transcatheter aortic valve implantation (TAVI) procedure at RHL-Rajasthan Hospital in Jaipur to replace the main cardiac valve without requiring open-heart surgery which was deemed too risky for the freedom fighter. The procedure was conducted by a team of experts led by Dr Ravinder Singh Rao, Vice-Chairman, Rajasthan Hospital & Visiting Cardiologist, Lilavati Hospital, Mumbai, using made-in-India equipment.

The surgery was witnessed live by interventional cardiologists from all around the globe who assembled for an annual conference in Chennai.

About the patient’s complication, Dr Rao said, “A heart 2-D Echo imaging of the patient revealed that she was suffering from aortic stenosis, which refers to the narrowing of the main valve. As a result, the heart had to pump with greater force against narrowed orifice. Gradually, her cardiac pumping efficiency decreased to 25 per cent and fluid started accumulating in the lungs. This made the patient breathless even on minimal activity.”

This came as a shock for her family members as the nonagenarian freedom fighter was leading an active life until a year ago. Gradually, she started developing shortness of breath – sitting up in the middle of the night due to breathlessness. She had to be hospitalised five times in a year. However, the one saving grace was that the patient was mentally sound and physically strong despite her advanced age and deteriorating condition.

Elaborating on the TAVI procedure done on the patient, Dr Rao said, “Endoscopic sutures were deployed in femoral (groin) artery. A big size tube was placed through which the valve was crossed and the new made-in-India one was placed inside the old valve. The new valve started functioning immediately. The tube was removed and the sutures were deployed to close the hole in the groin vessel, he said, adding the risk of suffering a stroke during the TAVI procedure was mitigated using a cerebral protection device.”

The technology of this made-in-India valve implant is both cost-effective as well keeping the quality aspect intact.

“Post-surgery, the patient stayed in the ICU for a day before she was shifted to a room. On the fifth day, she walked out of the hospital on her own. She was breathing and sleeping better – that is the miracle of TAVI,” the doctor added.

TAVI (transcatheter aortic valve implantation) is a minimally invasive non-surgical procedure using cutting-edge technology that allows doctors to replace a valve in the heart without removing the damaged one or without opening up the patient’s chest. It has become a boon for patients suffering from aortic stenosis.

A valve replacement is generally performed through open heart surgery with a “sternotomy” which required the chest to be opened up. Transcatheter aortic valve implantation or TAVI eliminated that requirement. For TAVI, a small opening needed to be made leaving all the chest bones intact.

While TAVI does involve a certain amount of risk, it is beneficial for many who may not have been considered for valve replacement. In terms of recovery, a patient’s experience with TAVI is like undergoing an angiogram with way lesser time spent in the hospital compared to a conventional valve replacement involving open heart surgery.

The first TAVI procedure in Rajasthan was done by Dr Rao in 2017. Since then, it has become an established, safe, and effective treatment for patients suffering from aortic stenosis. Research has shown that the outcomes depend on the operator’s experience and volume.