TAVI

Transcatheter Aortic Valve Implantation (TAVI) is a less invasive cardiac intervention used to substitute a narrowed aortic valve that is unable to open fully, a condition known as aortic valve stenosis. The aortic valve is situated between the left lower chamber of the heart (left ventricle) and the body's main artery (aorta). When the valve fails to open properly, it results in decreased blood flow from the heart to the body.

TAVI serves to reestablish proper blood circulation and alleviate the symptoms associated with aortic valve stenosis, which may include chest discomfort, breathlessness, loss of consciousness, and fatigue.

Why is Transcatheter Aortic Valve Implantation needed?

Transcatheter Aortic Valve Implantation might be a suitable choice for individuals who are suspected to face potential complications from conventional surgical aortic valve replacement (open-heart surgery). The decision to address aortic stenosis through TAVI is reached after consulting a team of cardiac specialists and surgeons, who collaborate to identify the optimal treatment avenue for such situations. Those who undergo TAVI typically experience a shorter hospital stay compared to those who undergo surgical aortic valve replacement.
Your doctor might suggest this procedure if you have:

• Severe aortic stenosis leading to observable signs and symptoms
• A biological tissue aortic valve that isn't functioning at its best
• Another medical condition, such as lung or kidney disease, that renders traditional open-heart valve replacement surgery too risky

The pre-evaluation is pivotal for ascertaining the appropriateness of TAVI as a viable approach and for mitigating possible risks in the perioperative and postoperative periods. Below is an overview of the pre-evaluation process:

• Echocardiogram: It is an imaging technique to examine the functioning of its muscles and valves
• Cardiac catheterization: It is carried out by a cardiologist via groin or wrist to assess the heart's arteries and measure internal pressures
• CT angiography (CT scan): It is a radiological procedure that is used to examine the blood vessels and the shape and dimensions of valves
• 5-meter gait speed: During an office visit, a timed walking test is conducted to evaluate frailty and the potential for surgery-related risks
• Electrocardiogram (ECG): It is a technique that is used to evaluate the electrical activity of the heart using chest patches during the hospital appointment
• Pulmonary function tests (PFTs): These tests are performed to identify lung issues, especially in patients with a history of lung problems or smoking
• Dental clearance: It is done for patients with natural teeth, a dentist's evaluation is necessary to check for ongoing infections. It is not obligatory for those with complete dentures
• Lab work: A non-fasting blood sample is required up to 45 days prior to valve replacement for testing various blood related parameters
• Urinalysis and urine culture: The testing of urine is done to detect infections before undergoing valve replacement
• Chest X-ray: It is necessary only if no CT scans or X-rays have been conducted within a year leading up to the valve replacement
• Trans-esophageal Echocardiogram (TEE): This invasive test examines heart valves, chambers, and function. It also assesses the diameter of the aorta. The entire process takes about 1 hour, with 2-3 hours for anesthesia recovery

During your TAVI procedure, you'll be taken to the procedure room either on a trolley or in a wheelchair and asked to lie down on a narrow table designed for the procedure. Throughout the process, you will remain awake, and your doctor will administer medication to help you to relax. The targeted area is numbed, and you'll receive either local anesthesia with sedation or a general anesthesia. This will be discussed with you prior to the procedure. A catheter with a balloon is inserted into an artery, either in your groin or beneath your collarbone. Skillfully guided into your heart, the balloon catheter is positioned within the opening of your aortic valve. Your doctor carefully inflates the balloon to expand the valve. A new aortic valve, held within a metal mesh tube, is implanted. The new valve either self-expands or is expanded using the balloon, depending on the valve type. The new valve is positioned to gently displace your damaged aortic valve. The balloon is deflated, and your doctor removes the balloon catheter.

Clinical trials have demonstrated the safety and efficacy of Transcatheter Aortic Valve Implantation (TAVI). Although it offers a less invasive option compared to conventional open-heart surgery, there remains a possibility of encountering complications. It's crucial to acknowledge that complications are not universally encountered, and a considerable number of TAVI procedures yield positive outcomes without notable problems. Nevertheless, here are several potential complications linked to TAVI:

• Valve Leakage: In certain instances, there might be blood seepage around the new valve due to factors such as insufficient size, incomplete expansion, or interference from calcium buildup. We have access to newer, more advanced models currently in the development stage that aim to address this issue.
• Pacemaker Requirement: Occasionally, as the valves are positioned, they can exert pressure on the heart's electrical system, necessitating the use of a pacemaker. Efforts are being made with newer models to mitigate this concern.
• Kidney Impairment: The contrast dye used for imaging purposes has the potential to harm the kidneys, although typically this is a reversible problem.
• Vessel Damage: The process of threading catheters through arteries bears a potential risk of damaging them. Fortunately, this damage is generally reparable either through catheter-based interventions or by means of open vascular surgery.
• Stroke Incidence: A small percentage of individuals undergoing TAVR have experienced strokes, either during the procedure itself or in the immediate days following it.
• Mortality Risk: While TAVR stands as an effective and often necessary treatment for individuals with more critical health conditions, the likelihood of not surviving the procedure remains extremely low.

After your Transcatheter Aortic Valve Implantation (TAVI), there's a possibility that you'll spend the night under monitoring in the intensive care unit (ICU). The duration of your hospital stay following this procedure hinges on various factors. Some TAVR recipients get discharged and head home as early as the next day.

Before you're discharged, your medical team will provide instructions on caring for any incisions and how to be vigilant for indications of infection. Red flags for infection encompass heightened body temperature, increased pain, as well as redness, swelling, discharge, or oozing at the catheter insertion site.

Following TAVI, you might be prescribed several medications, which include:

• Blood Thinners (Anticoagulants): These medications are given to forestall the formation of blood clots. 
• Antibiotics: Given the potential for bacterial infection in artificial heart valves, especially originating from oral bacteria, comprehensive oral hygiene and regular dental cleanings are imperative in averting such infections. Antibiotics are prescribed prior to specific dental procedures as a preventive measure.

After TAVR, it's imperative to attend regular medical checkups and undergo imaging tests to ensure the proper functionality of the newly implanted valve. In the event of any fresh or escalating symptoms, such as:

• Dizziness or feeling light-headed
• Swelling in the ankles
• Sudden unexplained weight gain
• Profound fatigue during physical activity
• Manifestations of infection
• If you experience the following, seek immediate medical assistance:
• Chest pain, pressure, or tightness
• Acute and severe shortness of breath
• Loss of consciousness (fainting)

Certain patients experience immediate relief from their symptoms shortly after undergoing the TAVI procedure, although it's common for a bit more time to be required to fully return to their regular state.

Research indicates that individuals who undergo TAVI frequently experience symptom reduction, enhanced self-care capabilities, improved heart function, and an overall better quality of life within the span of 30 days.

In many cases, patients can resume work within two weeks following the procedure. However,  there are certain limitations to be observed after Transcatheter Aortic Valve Implantation procedure, such as refraining from heavy lifting exceeding 5 to 10 lbs. for the initial week. For a week, driving is discouraged, and it's advised not to submerge the incision site(s) in water, including bathtubs, swimming pools, or hot tubs.

A follow-up appointment, typically scheduled for a week after the procedure, should be arranged. Within the subsequent 30 days, an echocardiogram is recommended, followed by annual echocardiograms conducted in collaboration with your cardiologist.

Following a TAVI procedure, the majority of individuals typically experience an improvement in their symptoms and an enhanced ability to engage in daily activities. However, a minority of patients might encounter complications subsequent to the TAVI procedure. The likelihood of complications varies according to the patient’s general health status and the specific condition of the heart.

 As a result of the hemodynamic and functional impacts of TAVI, there has been a notable enhancement in the immediate and medium-term survival rates among individuals with aortic stenosis (AS). According to research, the survival rates of 92.9%, 78.6%, and 73.7% were observed at 30 days, 1 year, and 2 years post-TAVI, respectively which indicates a remarkable improvement. Various studies have indicated that the transfemoral approach yields superior survival outcomes when contrasted with alternative approaches.

India's healthcare system capitalizes on decreased labor and infrastructure costs, enabling healthcare establishments to furnish services at more affordable prices. Moreover, the presence of proficient medical experts combined with a competitive market cultivates economically efficient approaches. Additionally, India's thriving pharmaceutical sector frequently manufactures generic drugs, which contributes to a decrease in the overall cost of treatment. This is the reason for the relatively reduced cost of Transcatheter Aortic Valve Implantation in India in comparison to other nations like USA where this cost is USD 50700 which is comparatively too high.

Nonetheless, the cost of Transcatheter Aortic Valve Implantation in India might fluctuate contingent on the subsequent key aspects:

• Health insurance coverage
• Out of pocket expense
• Admission charges
• Cardiologist remuneration
• Patient's age
• Severity of aortic stenosis
• Type of treatment approach
• Patient's medical state
• Diagnostic procedure charges
• Medication cost
• Complications encountered post-procedure
• Hospital category
• Chosen room category for admission
• Additional laboratory or diagnostic assessments like X-rays, ECGs, Echo, and others

The expenses associated with the preliminary assessments and examinations conducted prior to the Transcatheter Aortic Valve Implantation might cover various diagnostic procedures. These additional charges encompass tests such as X-rays, CT scans (computed tomography), MRI scans (magnetic resonance imaging), pulmonary function tests (PFTs), carotid doppler/ultrasound studies (carotids), a, surface echocardiograms (Echo), trans-esophageal echocardiograms (TEE), heart catheterization (Cath), and other diagnostic evaluations. The total expenses for these tests can vary between INR 1,00,000 and INR 1,50,000.

MedFlick, your trusted healthcare companion, is dedicated to ensuring that your medical journey goes as smoothly and successfully as possible.

• Individualized Guidance: Personalized guidance throughout your medical journey.
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• Transparent and Competitive Pricing: A full breakdown of treatment costs that eliminates surprises and offers you cost-effective solutions.
• MedFlick provides everything from travel arrangements to hotel and visa help to lodging.
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• The road to a successful Transcatheter Aortic Valve Implantation procedure is long and winding, full of hope, resilience, and the promise of a brighter future. With MedFlick as your guide, navigating this life-changing adventure becomes simple and liberating.