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Healthcare Delivery

Surgical Case Study: Medicover Hospitals-Transcatheter Aortic Value Replacement (TAVR)

(Below is a case study from the Medicover Hospitals in Hyderabad)

A 65-year-old male with systemic hypertension presented with Class II DOE. He had undergone IVUS-guided PTCA to LMCA and mid LAD along with PTA to left ICA in 2015. He has a history of peripheral artery disease (right leg claudication), severe restrictive and obstructive lung defect, and S/P right iliac stenting (2015).

2D Echo showing calcified bicuspid Aortic valve

Further evaluation of the echocardiography revealed a bicuspid aortic valve with severe calcified aortic stenosis. He approached us for transcatheter aortic valve implantation/replacement (TAVI/TAVR). Transcatheter aortic valve replacement was a necessary option due to his high-risk surgical profile (renal dysfunction, COPD, bicuspid valve, and coronary status) and to improve his quality of life.

CT with Aortic valve dimensions

After discussion with the Heart Team (Interventional Cardiologists, Cardiac Surgeons, and Cardiac Anaesthetists), we decided to go ahead with TAVR under conscious sedation due to poor lung function. After thorough CT analysis, we proceeded with a 23 mm Sapien-3 valve, which was deployed through the femoral artery.

We used Preclose ProGlide Closure device to manage the arterial puncture site. The procedure was completed within an hour and a half, and the aortic valve gradient reduced from 107/70 to 20/11. The aortic valve was replaced in a single sitting without the need for coronary revascularization and conversion to open-heart surgery. He was mobilized within two days and discharged on day 5.

Coronary Angiographic image showing Transcatheter Aortic value implantation of 26 mm Sapiens -3 valve

TAVR is an excellent alternative for all patients with high surgical risk (STS score > 4, Logistic Euro Score > 10, Re-do surgery and post-chest radiotherapy patients, and patients with multiple-organ dysfunction).

Authorerd by  Dr. Sharath Reddy & Team, Medicover Hospitals, Hitech City, Hyderabad