Transcatheter Aortic Valve Replacement at Narayana Health

About Narayana Health City

Narayana Health City in Bommasandra, Bengaluru was established with the vision to make high-end quality healthcare, including tertiary care facilities affordable and accessible to all.
Some of the Key facilities offered at Narayana Health City are specialized Cardiac OTs, Digital Cathlabs, a Hybrid Cath lab, State-of-the-Art CCU, an 80 bed PICU – One of the largest in the world, Heart Failure Clinic, Cardiopulmonary Exercise Test (CPET) Facility, Valve Repair Clinic, Adult Congenital Heart Diseases Clinic and Electrophysiology Centre.

Why choose Narayana Health City

One of the few centers in India to perform TAVR surgery
One of the few centers in India to operate all 4 heart valves
Intensive care and monitoring of high risk patients using ECMO (specialized life support equipment)
Team of highly experienced multidisciplinary cardiac experts

What is Aortic Stenosis?

Aortic stenosis is an ailment that leads to the narrowing of the aortic valve of the heart, which normally allows blood ﬂow to be pumped from the main chamber of heart to the rest of body.

The narrowing of this valve can lead to an increased amount of stress and pressure on the heart muscle, which in turn can lead to symptoms of chest discomfort, shortness of breath, legswelling, fatigue , lightheadedness, syncope, and even sudden death.

The most common cause of aortic stenosis is calciﬁcation of the valve, caused due to degeneration that comes with age.

Other causes include damage to the heart valves due to diseases like rheumatic heart disease, or congenital heart defects like bicuspid aortic valve, misshapen tricuspid aortic valve, or a unicuspid valve.

TAVR or TAVI stands for transcatheter aortic valve replacement or implantation. It is a relatively new technology which serves as an alternative to standard aortic valve replacement surgery.

This procedure is a minimally invasive procedure that allows the cardiologist to cure a severely narrowed aortic valve without opening up the patient's chest by replacing the valve without removing the old, damaged valve.

What is a TAVR? (Also called TAVI)

This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve's place. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

What is involved in a TAVR procedure?

Usually valve replacement requires an open heart procedure with a “sternotomy.”, in which the chest is surgically separated (open) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place.

A TAVR procedure is not without risks, but it provides beneﬁcial treatment options to people who may not have been candidates for them a few years ago while also providing the added bonus of a faster recovery in most cases. A patient's experience with a TAVR procedure may be comparable to a balloon treatment or even an angiogram in terms of down time and recovery, and will likely require a shorter hospital stay (average 3-5 days).

The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

There are two different approaches to the TAVR procedure, and the cardiologist or surgeon chooses the one that provides the safest way to access the valve:

Transfemoral approach: Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest, or
Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

How is TAVR or TAVI different from the standard valve replacement?

This procedure is fairly new and is FDA approved for people with symptomatic aortic stenosis who are considered an intermediate or high risk patient for standard valve replacement surgery. The differences in the two procedures are signiﬁcant.

Valve-within-valve — How does it work?

Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter.

Once the new valve is expanded, it pushes the old valve leaﬂets out of the way and the tissue in the replacement valve takes over the job of regulating blood ﬂow.

Who is a good candidate for this type of valve surgery?

At this time the procedure is reserved for those people for whom an open heart procedure poses intermediate risk. For that reason, most people who have this procedure are in their 70s or 80 and often have other medical conditions that make them a better candidate for this type of surgery.

TAVR can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.

How long does the transcatheter valve replacement (TAVR) procedure take?

The transcatheter valve replacement (TAVR) procedure takes 45 to 60 minutes. Going into the room, having the procedure performed and leaving the room takes two to three hours.

The transcatheter valve replacement (TAVR) procedure takes about an hour and a half to two hours. However, the total time in the operating room is a bit longer due to setup and recovery. Therefore, the total time in the operating room is usually about four hours.

How long does it take to recover from a Tavi operation?

The transcatheter valve replacement (TAVR) procedure takes 45 to 60 minutes. Going into the room, having the procedure performed and leaving the room takes two to three hours. The transcatheter valve replacement (TAVR) procedure takes about an hour and a half to two hours.

How long does TAVR last?

Benefits of TAVR

Minimally invasive procedure
Less painful than the traditional open-heart surgery
Shorter Hospital Stay
Offers improved quality of life in patients who cannot undergo traditional aortic valve replacement
Surgery performed under local anaesthesia

Some of the key facilities we offer:

Digital Cath Labs

Narayana houses 6 digital cath labs with state of the art, sophisticated equipment with the objective to provide only the best to those who lay their trust with us. Recent developments in cardiac surgery and interventional cardiology with new alternatives for aneurysm repair, valve replacements, shunt closure devices and aortic arch reconstruction have led to the creation of integrated, hybrid cath lab that allow both surgical and endovascular procedures.

These Hybrid Cath labs offer both surgical equipment and high-end angiographic equipment providing the best of both worlds.

Cardiopulmonary Exercise Test (CPET) Facility

Cardiopulmonary Exercise Testing (CPET) is a non-invasive method used to assess the performance of the heart and lungs at rest and during exercise. It requires the patient to perform mild exercises on an upright bicycle whilst breathing through a mouthpiece. Each breath is measured to assess how the body is performing and the capacity and strength of the lungs is measured before and during exercise. The heart tracing (ECG) is also recorded prior to, during and post exercise. Narayana offers in house CPET Facility to ensure complete convenience of the patients.

Electrophysiology Centre

Electrophysiology studies (EPS) are tests that help doctors understand the nature of abnormal heart rhythms (arrhythmias). The technique is used by doctors to assess the reason behind the abnormal beating of a person’s heart. In a normal scenario, electrical signals travel through the heart in a regular pattern. Heart attacks, aging and high blood pressure may cause scarring of the heart which may further cause the heart to beat in an irregular (uneven) pattern. During EPS, doctors insert a thin tube called a catheter into a blood vessel that leads to the heart. The electrical signals are studied through a specialized electrode catheter which lets the doctors send electrical signals to your heart and record its electrical activity. Narayana offers a state-of-the-art Electrophysiology Centre with specialized equipment for maximum convenience.

Heart Failure Clinic

Heart failure, sometimes known as congestive heart failure, occurs when the heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually leave the heart too weak or stiff to fill and pump efficiently. One can improve the quality of life by making lifestyle changes such as exercising, reducing sodium in your diet, managing stress and losing weight. Narayana houses a specialized heart failure center to ensure the highest quality of services are provided to the patients with utmost care.

Adult congenital heart disease clinic

Congenital heart disease (congenital heart defect) is one or more abnormalities in the heart structure that one is born with. It is one of the most common birth defects which can alter the way blood flows through one’s heart. Defects range from simple, which might cause no problems, to complex, which can cause life-threatening complications. Advances in diagnosis and treatment mean most babies who once died of congenital heart disease survive well into adulthood. However, signs and symptoms of the condition can occur in adults later in life, even those who had undergone treatment as a child.

Having a congenital heart disease may mean that one needs care throughout one’s life. Narayana has, at its heart a specialized Adult Congenital Heart Diseases Clinic ensuring the best in class service for its patients.

State-of-the-art critical care unit

A CCU or Critical Care Unit, is a special department of a hospital or health care facility that provides intensive treatment medicine and caters to patients with severe or life-threatening illnesses and injuries, which require constant care, close supervision from life support equipment and medication in order to ensure normal bodily functions. The CCU at Narayana is staffed with highly trained physicians, nurses and respiratory therapists who specialize in caring for critically ill patients. It is also distinguished from general hospital wards by a higher staff-to-patient ratio and access to advanced medical resources and equipment that is not routinely available elsewhere. Common conditions that are treated within CCUs include acute (or adult) respiratory distress syndrome, hypertension, metastases and other life-threatening conditions.

Valve Repair Clinic

Aortic valve repair is a procedure that is used to treat diseases affecting the aortic valve. The aortic valve is one of four valves that regulate blood flow through the heart. These valves keep blood flowing in the correct direction through the heart. When the aortic valve isn't working properly, it can interfere with blood flow as well as force the heart to work harder to supply the necessary blood to the rest of your body. Aortic valve disease may not cause any signs or symptoms for many years, in some people while others may experience shortness of breath, fatigue, chest pain, loss of consciousness, irregular heartbeat (arrhythmia), heart failure and sudden cardiac death. With the specialised treatment provided at the Valve Repair clinic at Narayana, Aortic valve repair or aortic valve replacement can treat aortic valve diseases and help restore normal blood flow, reduce symptoms, prolong life and help preserve the function of one’s heart muscle.

Transcatheter Aortic Valve Replacement in Bangalore