• 74-year-old patient had multiple comorbidities like Triple vessel disease, Severe Aortic Stenosis, uncontrolled Diabetes Mellitus, Hypertension and Hypothyroidism which made open heart surgery impossible for him
• TAVR was the most preferred option in such cases, but unavailability of device increased the challenges amidst the lockdown.
• Patient therefore underwent a temporary complex procedure Balloon Aortic Valvuloplasty to tide the lockdown period.
• Post lockdown, patient underwent another complex procedure TAVR which saved his life and he is leading a quality life now

BLK Hospitals announced that they have successfully saved the life of a 74-year-old man from West Delhi by performing TAVR (Transcatheter aortic valve replacement) surgery. Lal Singh, the patient, was diagnosed with tight obstruction of the aortic valve due to which his heart was only 15-20% functional and could pump very little blood to his body.

Such cases usually undergo surgical aortic valve replacement, but due the limitations of comorbidity as the patient had a history of uncontrolled diabetes mellitus, hypertension and hypothyroidism, triple vessel disease and severe aortic stenosis, TAVR was the preferred option, according to Dr.Ajay Kaul, Chairman & HOD, Cardiothoracic and Vascular Surgery, BLK Heart Centre, BLK Super Speciality Hospital, who conducted the surgery along with his team.

However, the operation was not as easy and uneventful. Lal Singh’s heart was very weak and arranging a valve would have required 2-3 days’ time or more, due to the COVID-induced lockdown phase in May. Lal’s condition was deteriorating, so the doctors intervened immediately and carried out his treatment in phases. Firstly, the doctors decided to go for a complex procedure called Balloon Aortic Valvuloplasty (BAV) to buy more time for Lal Singh. This involved balloon dilatation of the valve to release the obstruction. The procedure was temporary, yet a very complex one and was carried out successfully. The patient was discharged in 3 days’ time.

In June, the patient had repeated incidences of unconsciousness and a failing heart. He was immediately rushed to BLK Hospital where he was taken in for aortic valve replacement (TAVR) on June 11th. This procedure was conducted successfully, and patient was discharged without any complications.

Said Dr.Ajay Kaul, “As soon as the lockdown got over we arranged the valve and went ahead for TAVR procedure to give him a good quality of life. We used the minimalist approach to perform TAVR under general anaesthesia and surgical exposure of arteries and no invasive central lines which saved the patient from going in complexities like excessive loss of blood and transfusion. By following the minimalistic approach, we got the best clinical outcome for the procedure which lasted close to an hour.”

“We performed both the procedures with utmost safety both for the patient and for our team in this pandemic time. Patient got discharged on day 3 of the procedure and is doing well” added Dr. Kaul,  who is amongst few cardiac surgeons in the world  and the only in India certified to perform structural heart interventions and surgery in collaboration with the heart team and treats serious heart ailments with hybrid Trans Catheter Therapeutic approach.

Said Dr. Sanjay Mehta, Unit Head and Vice President, BLK Super Speciality Hospital said, “BLK Hospital is capable and committed to save lives and conduct complex and difficult procedures even during the times of the pandemic.  Our emergency rooms, centres of excellence and other departments are open, and we continue to deliver the highest level of care. Timely intervention and the will to heal, help us save precious lives.”

Other team members who contributed to the success of this procedure work were Dr. Subhash Chandra – Chairman Cardiology, Dr. Neeraj Bhalla – Sr. Director, Cardiology, Dr. Dheeraj Gandotra – Sr. Consultant,Dr. Sanjeev Gera- Cardiology, Dr. Jasbir Khanuja- Sr. Consultant, Anesthesia and Dr. Sameer, Anesthesia department among others.

Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive surgical procedure, which repairs the valve without removing the damaged valve. Instead, a replacement valve is lodged into the place of the aortic valves. This procedure is for people who have been diagnosed with severe Aortic Stenosis and are considered either high-risk or too sick for surgical valve replacement.