Yet Another Milestone for Dr. Sarat Chandra
He has successfully Performed Two TAVRs (TAVI) on the Same Day.
The First Case
A record of sorts was made on the 5th of this month when Dr. Sarat Chandra performed two TAVRs on the same day. TAVR stands for trans catheter aortic valve replacement. This is cutting-edge technology. The first case was a 75-year-old man with severe aortic valve stenosis with a gradient of 70/42 mm. After a complete evaluation, it was found that the valve is tricuspid. The patient also had severe lung disease in the form of COAD and bronchiectasis. The patient was advised to undergo AVR by TAVR which is basically a non-operative technique to treat the aortic stenosis. The procedure was done with an “MYVAL” by MERIL. The device used was 27.5 mm in diameter. The procedure was done through the right external iliac artery and the gradient came down to 3 mm. The patient recovered smoothly.
This video shows Aortic root angiography demonstrating calcification of the aortic valve and coronary Ostia well above the aortic leaflets which are doming.
This video shows a stiff wire inside the left ventricle (over which the valve will be implanted). Also seen are temporary pacemaker lead in the right ventricle and pigtail catheter in the aortic root.
This video shows the crimped prosthetic valve being positioned across the aortic annulus. Precise positioning is extremely crucial.
This video shows rapid pacing of the heart with resultant stabilization of the device followed by expansion of the balloon and the implantation of the device.
This video shows a properly implanted device with no compromise of coronaries and no aortic regurgitation.
The Second Case
A second case is a 63-year-old man who had severe AS with a gradient of 120 mm hg at peak of systole. He was very keen on undergoing TAVR and wanted to avoid surgery at all costs. He had no comorbidities. In this case, the valve was bicuspid and calcified heavily. Here we have implanted an “MYVAL” 26 mm with a fall of the gradient to 0-5 mm at the end of the procedure. This patient also recovered uneventfully.
TAVR (also called TAVI) is a non-surgical method of replacing the aortic valve that is stenosed. It avoids the opening of the chest and makes recovery smooth. Since this disease often presents in the older population, the surgery by the conventional method is associated with a variety of complications like wound infection, stroke, and lung complications. All these are associated with increased mortality and morbidity. The procedure is fast catching up in India like in the rest of the world. The cost of the devices used is also coming down. It is expected that open-heart surgery may become a thing of the past with TAVR gaining popularity.