Patient information

Everything you need to know about Transcatheter Valve therapy in one place and more importantly accurate !
What is TAVI or TAVR?
They both mean the same procedure. This involves implanting a new artificial aortic valve without open heart surgery, predominately through a blood vessel in the leg, but less commonly through the chest wall or the shoulder. The valve itself if made of an outer metal frame onto which tissue processed from cow’s heart is stitched on to create a valve. This artificial valve is crimped in a catheter which is used to deliver the valve to its intended position namely the aortic valve position

What tests to I need before a TAVI/TAVR?
To check if you are suitable for TAVI and to see if you would gain benefit from TAVI, you will first need to be assessed by a TAVI expert. This includes clinical examination and your over health assessment to assess if your quality of life will improve with TAVI. You will then have to undergo tests such as an ECG, an Echocardiogram, lung function tests and blood tests. To know if your heart and blood vessels are suitable for the TAVI, you will almost certainly need a CT scan off your heart and blood vessels. You may also need a coronary angiogram to assess your heart blood vessels. The requirement for each patients will be geared according to the patient and this will be advised by the TAVI expert who is assessing the patient.

How is the Procedure Performed?
This is variable and depends on the specialist’s experience and the centre’s experience. Majority of procedures performed by experts at India Valves are under local anaesthesia. General anaesthesia is used for patients who have specific reasons which your doctor will explain to you. Anaesthesia does not increase the risk of the procedure significantly. Simple TAVI procedures takes usually one hour to two. Some complex TAVI procedures can take a few hours to complete. In the majority of cases, the valve is delivered through a small hole made in the groin through which is catheter is taken up to the heart where the valve is delivered securely. In a minority of the procedures, your doctor may chose to go through the chest wall or through a small hole in the shoulder. Your doctors would usually explain to you in much detail of the exact procedure proposed for you.

What happens after the procedure?
You would be normally taken to the intensive care unit where you would be monitored. Most procedures would only involve over night stay in the ICU however some sick patients may require longer time. This would be detailed by your doctor if necessary. Majority of patients are shifted to the ward on day 2 and are usually discharged home in 3 to 5 days into hospital admission. This is the case for simple TAVI procedures. However complex TAVI procedures may require longer time in hospital which would be detailed by your doctor.

What is the world wide evidence for TAVI/TAVR?
Several hundreds of thousands of patients have been treated world wide successfully. The valves used for TAVI or TAVR have been shown to be similar in quality and longevity to surgically replaced tissue valves. TAVI in the past was mainly used to treat high risk patients who are unable to have open surgical treatment due to frailty of other diseases co-existing. But the therapy has been proving itself superior in many aspects compared to surgical aortic valve replacement and patients and physicians across the world have adopted this technique widely. More recently world wide published evidence from randomised studies have shown TAVI to be non-inferior to surgical aortic valve replacements in moderate risk patients too who would have traditionally had open surgical aortic valve replacements. This study also suggested that the rates of stroke were much lesser with TAVI compared to open surgical aortic valve replacement. Moreover the return to normal quality of life was far superior with TAVI compared to surgical aortic valve replacement. Early results from studies across the world assessing the outcomes of TAVI in low risk patients have also showed the TAVI is favourable to surgical aortic valve replacements. But long term data on such patients are awaited.

What do the major international medical guidelines state in terms of best practice?
World wide expert consensus suggest that TAVI is the preferred treatment to surgical aortic valve replacement in elderly and frail patients who may be high risk for surgical aortic valve replacements. It also suggests that TAVI is a reasonable option for intermediate risk patients who would otherwise qualify for surgical aortic valve replacement.

The American Heart Association (AHA), American College of Cardiology (ACC) and the European Society of Cardiology (ESC) have released guidelines suggesting that upon recommendation by a team of experts namely ‘Heart Team’, TAVI is the treatment of choice for high risk patient with aortic stenosis and TAVI is a reasonable option for intermediate risk patients too who are otherwise suitable for surgical aortic valve replacement.

What are the specific advantages of TAVI/TAVR over open surgical aortic valve replacement?
This question assumes that your doctor has recommended TAVI as a potential option or the preferred option for your aortic valve disease. Assuming that is the case, an uncomplicated TAVI procedure performed by expert teams allows for very short hospitalisation usually 3 to 5 days. There are no large scars on the chest well. The recovery to normal quality of life is within a few days.
World wide experience from thousands of patients have shown that quality of life after TAVI is superior to surgical aortic valve replacement of similar cohort of patients.

What are the risks of TAVI?
The risks to having a TAVI are multiple and may include bleeding, blood vessel damage, heart attack, stroke and emergency heart operation. The risks are similar to the risks of surgical aortic valve replacement. The overall risk to a TAVI procedure performed by expert teams is 2% to 3%. You may need additional treatments such as Implantation of a Permanent Pacemaker after or before the TAVI procedure if your doctor feels you may need that too. This is only in a minority of patients.

How do I get an opinion as to whether I would benefit from TAVI compared to Surgical Aortic Valve Replacement?
You are recommended to meet an accredited TAVI expert who go through your information. He or she may perform some tests to assess your condition. The expert will then conduct a ‘Heart Team’ discussion where a team of experts will discuss and arrive at a conclusion as to which is the best treatment option for you, TAVI or Surgical Aortic Valve Replacement..

How do I contact a TAVI expert or a TAVI centre?
India Valves has a national database of centres and experts in the field of TAVI. These are centres who have come forward to be included as part of this national forum for patients. India Valves has assessed those centres with a team of national experts and have listed those who have substantial experience in preforming TAVIs and Surgical Aortic Valve Replacements. There may be other centres also who may have expertise in the field of TAVI which are not entered on this website. This is either because they have not come forward to be listed on this website or have not completed their assessments successfully to be included as an accredited centre on this website.

How does India Valves include a centre as an accredited centre for TAVI?
India Valves has a team of national experts who form the accrediting committee for centres to be included as TAVI centres on this website. The committee looks at various aspects of care and processes in place in that centre. On of the important criteria for a centre to be accredited is that the centre should agree to disclose all their TAVI procedures and enter them onto a national database where each centre’s performance including volumes and outcomes can be assessed. In addition, the committee looks at the expertise of the team, infrastructure, technology used and follow-up protocols in place before accrediting a centre on to India Valves website.

The intention and mission of India Valves is to have a transparent system for patients to get information and for them to make an informed decision. In addition India Valves aims at having nationalised accredited centres as adopted in western countries to make sure patient safety and successful outcomes for patients are ensured in the best interests of patients. One of the mission of India Valves is to have a small number of centres in the country doing high volumes rather than a large number of centres doing low volumes in each. This is because, world wide evidence has shown that outcomes of TAVI/TAVR is best achieved in high volume centres than low volume centres. It is therefore common to find only one or two centres in a city or town as accredited centres by India Valves. Centres are only accredited based on geographical needs as decided by the committee.

How do I contact India Valves for advice?
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