Amid the ongoing pandemic, a pioneering transcatheter aortic valve replacement (TAVR) was performed on a 62-year-old farmer who was brought to the Sir HN Reliance Foundation Hospital with heart failure. Doctors took just four hours to successfully perform this elective surgery, the logistics of which alone take 15-17 to days.
The special valve-in-valve procedure was performed within four hours of the patient’s relatives and doctors agreeing to it, also a record in itself.
Doctors said the patient was brought to the hospital on June 20 and at the time of admission, he had had very low blood pressure, no urine output and swelling all over the body, suggestive of severe heart failure.
“When we assessed the patient in our emergency ward, we knew he had severe heart failure because of the dysfunction of one of his artificial heart valves implanted in an open heart surgery six years ago. We immediately put him on dialysis and multiple medications, to increase his falling blood pressure,” said Dr Maulik Parekh, cardiologist at the Sir HNRFH and head of the medical team for the TAVR.
He said while the medical team as sure the patient needed a valve replacement, a redo open heart surgery was considered to be extremely high risk because of his critical condition and previous surgery. "Hence, we offered the Transcatheter Aortic Valve Replacement (TAVR) as a safer alternative," Dr Parekh said.
“The TAVR is a complex, thoughminimally invasive cardiac procedure to treat severe narrowing (stenosis) of the aortic valve (valve between heart and the main blood vessel). Once the patient’s relatives gave the go-ahead, within a short time of four hours, the patient was wheeled in for the procedure, ” Dr Parekh informed.
Usually, the logistics for the TAVR, a planned/elective procedure, takes 15-17 days, requiring the patient to undergo a battery of diagnostic tests, planning a team of doctors, deciding on the right size of the valve etc.
The planning of the TAVR was a herculean task, as the patient was critical and was unfit for a CT scan required to find the right size of the valve. With his deteriorating health, it was a race against time to order the right-sized valve in a short time. “In the hour-long procedure, cardiologists inserted a new valve inside the previously implanted valve which had failed, without opening the chest. For this patient, TAVR turned out to be a life-saving procedure. Within two hours of the procedure, all his vital parameters were in control. He was discharged on July 2,” said Dr Parekh.
