What Is TAVR?

Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve Implantation (TAVI) is a medical procedure that replaces the aortic valve in high-risk patients during an open heart surgery. During this procedure, the old valve that is damaged is replaced with a new artificial valve without actually removing it. A specialised catheter, similar to a stent as in stenting, is used to conduct the operation. An interventional radiologist, cardiac anaesthesiologist, and invasive cardiologist are required to carry out the procedure. This team of experts only decide whether the procedure is suitable for the high-risk patient or not. This also includes a proper clinical examination, echocardiogram, CT scan and a cardiac catheterization.
TAVR could be seen as an option for an elderly patient who has aortic stenosis that leads to harmful symptoms. This is because chances are such patients (60 yrs or above) will have other medical conditions, which make open heart surgery not viable for them. However, before any decision is taken, the patient’s condition must be thoroughly evaluated by a team of heart valve experts. Doctors need to examine the condition at length, to check whether the treatment is appropriate or not.
The procedure for TAVR is done using three different methods. The first is done by entering the large artery in the groin area. This will not require a surgical incision in the chest, and is called the transfemoral approach. The second and third methods are a bit invasive, as a small incision needs to be made in the chest, in order to access the large artery. It could be done through the apex of the heart – aka transapical approach – or through the ascending aorta of the heart – aka transaortic approach.
TAVR is an effective option for those who are not eligible for other treatment options and thus, reigniting a hope of improved quality of life for them.
Dr. Sai Satish was among the first few to get trained in TAVI – the non-surgical form of valve replacement way back in 2008.Initially this procedure was only approved for those with prohibitive risk for open heart surgery, the inoperable cases that were condemned to a miserable quality of life and high mortality. Then the US FDA rapidly realised its potential to save lives and approved the procedure for high risk cases and intermediate risk patients as well. Somewhere along the way India woke up and adopted this form of treatment,” says Dr Satish who has worked in Hungary as a “Senior Interventional Cardiologist” in one of the best TAVI training centres in the world and is one amongst a handful across the sub-continent who is licensed to implant these valves independently. 

He has conducted several training sessions and live case demonstrations, to train other doctors in this non-surgical form of valve replacement in and outside India. He recently trained the team and started Sri Lanka’s 1st TAVI programme, helping implant the country’s first few valves. He is also invited routinely as faculty at several national/international conferences as an expert in the field.