What would you do if an elderly patient with severe heart disease also had advanced liver cirrhosis and a high risk of bleeding? This was exactly the dilemma faced by the team at Medicover Hospitals, led by Dr. Tamiruddin A. Danwade. Here’s how the team navigated this challenging case.
The Patient’s Story
An 80-year-old gentleman came to Medicover Hospitals with worsening breathlessness. His medical history was already complex: – A heart bypass 10 years ago – A pacemaker 5 years ago for complete heart block – Cirrhosis from NASH, diagnosed two years ago, leaving him with very low blood counts (platelets < 50,000/uL)
On examination, a harsh murmur was heard, and scans confirmed what was feared — severe aortic stenosis. To make matters harder, his heart’s pumping efficiency (LVEF) was only 30%.
Now here’s the problem: in someone with advanced cirrhosis and low platelets, open-heart surgery is just too risky. So, what were the options?
The Decision
The multidisciplinary Heart Team at Medicover — cardiology, hepatology, haematology, and anesthesiology — led by Dr. Danwade, came together. After weighing the risks, surgery was ruled out. The best chance for this patient was Transcatheter Aortic Valve Implantation (TAVI) — a minimally invasive approach.
The Procedure
The team proceeded with transfemoral TAVI under local anaesthesia. Through the right femoral artery, they carefully guided and deployed a 29 mm Meryl Myval valve. Given his dangerously low platelets, a single unit was transfused just to be safe.
The result? Smooth. The patient remained stable, with no bleeding or vascular complications. He was walking within 12 hours and back home in 48 hours — on a single antiplatelet agent only.
Why This Case Matters
So, what makes this case special? Patients with cirrhosis and very low platelets are often considered “too high risk” for procedures like TAVI. The fear is understandable: bleeding, complications, prolonged ICU stays.
However, this case at Medicover reveals something different: with the right planning, teamwork, and minimalist strategy, TAVI can be effective even in patients once thought untreatable.
Recent studies also support this approach. Using single antiplatelet therapy instead of the traditional dual strategy, and adopting a minimalist technique, can reduce complications in patients with high bleeding risk and liver dysfunction.
Takeaway
For this patient, TAVI wasn’t just a procedure — it restored his quality of life. For the Medicover team led by Dr. Tamiruddin A. Danwade, it was a reminder that while evidence from trials is important, real-world experience often pushes the boundaries further.
Cases like this also highlight how the Indian healthcare system has come a long way in managing complex, high-risk conditions with cutting-edge procedures that match global standards. With careful planning and multidisciplinary collaboration, the scope of TAVI can be safely expanded to help even the most challenging patients.
