TAVI / TAVR Procedure in Hyderabad

What is Aortic Stenosis?

The aortic valve sits between the left ventricle and the aorta, the body's main artery. It opens to allow blood to be pumped out of the heart and closes to prevent backflow. In aortic stenosis, the valve leaflets become thickened and calcified over time, reducing the valve opening and restricting blood flow out of the heart.

The heart compensates initially by pumping harder, causing the left ventricle to thicken. As the valve becomes severely narrowed, the heart can no longer compensate. The classic symptoms of severe aortic stenosis, chest pain on exertion, fainting or near-fainting, and breathlessness, signal a point at which the condition becomes rapidly life-threatening without valve replacement. Without treatment, the median survival after symptom onset is 2 to 3 years.

Aortic stenosis is the most common valve disease requiring intervention in adults over 65, and its prevalence rises sharply with age. It affects approximately 3 to 5% of people over 75 in developed populations.

Who is TAVI Recommended For?

High Surgical Risk

Patients with severe aortic stenosis who are considered too high-risk for conventional open-heart surgery due to advanced age, frailty, previous cardiac surgery, significant lung disease, or major comorbidities. TAVI was originally validated in this group.

Intermediate Surgical Risk

Multiple large trials (PARTNER 2, SURTAVI) demonstrated that TAVI is non-inferior to surgical valve replacement in intermediate-risk patients, with lower rates of stroke and bleeding.

Lower Surgical Risk

The PARTNER 3 and Evolut Low Risk trials showed TAVI superiority or equivalence to surgery in low-risk patients under 70 at two-year follow-up, leading to expanding use in younger patients.

Valve-in-Valve TAVI

Patients with a previously implanted surgical bioprosthetic valve that has deteriorated can have a TAVI valve deployed within the old valve without reoperation.

Specific Anatomical Suitability

TAVI requires adequate femoral artery size for catheter access and appropriate aortic anatomy. CT assessment determines suitability before the procedure.

Patients suitable for both TAVI and surgical valve replacement are discussed at our structural heart multidisciplinary team meeting, which includes interventional cardiologists and cardiac surgeons. The goal is always the option most likely to provide the best long-term outcome for that individual. Learn more about surgical valve replacement.

The TAVI Procedure: Step by Step

Pre-Procedure Planning:

A CT scan of the aorta and access vessels is essential for planning. It measures the size of the aortic valve annulus to select the correct prosthesis size and assesses the access route. A coronary angiogram is also performed to evaluate the coronary arteries before proceeding.

Multidisciplinary Team Decision:

The heart team formally agrees on the procedure based on imaging, risk assessment, and patient preferences.

Anesthesia:

TAVI is performed under general anesthesia or, increasingly, under conscious sedation (the patient is sedated but breathing independently). Sedation is preferred at many centers for lower-risk patients as it reduces intensive care admission and hospital stay.

Access:

In the transfemoral approach (preferred in over 85% of cases), a sheath is placed in the femoral artery in the groin. Alternative access sites (subclavian artery, transaortic, or transcaval) are used when the femoral vessels are too small or diseased.

Crossing the Valve:

A guidewire is passed through the diseased aortic valve under X-ray imaging.

Pre-dilation (Balloon Valvuloplasty):

In some cases, a balloon is first inflated within the narrowed valve to create space for the prosthesis. This step is omitted with some newer valve systems.

Valve Deployment:

The replacement valve, a biological valve made from bovine or porcine pericardium mounted on a metal frame, is delivered on a catheter and positioned precisely at the level of the native aortic valve. The valve is then expanded, either by balloon inflation or self-expansion, and immediately begins functioning.

Assessment:

Echocardiography and angiography confirm correct valve positioning, function, and the absence of significant leakage.

Recovery:

The access site is closed with a vascular closure device. Most patients are transferred to the cardiac ward (not ICU) the same day and are discharged within 2 to 3 days.

The TAVI procedure typically takes 1 to 2 hours. Most patients are walking the following morning and discharged within 2 to 3 days, compared to 5 to 7 days for surgical valve replacement.

TAVI vs Surgical Valve Replacement

Incision

TAVI: Catheter through a small groin puncture. Surgery: Full sternotomy (breastbone divided).

Heart-Lung Bypass

TAVI: Not required. Surgery: Required for conventional open repair.

Hospital Stay

TAVI: 2 to 3 days. Surgery: 5 to 8 days.

Recovery Time

TAVI: 1 to 2 weeks to light activity. Surgery: 6 to 8 weeks.

Stroke Risk

TAVI: Slightly higher in some trials. Newer devices and embolic protection have reduced this significantly.

Paravalvular Leak

TAVI: Slightly higher rate of mild paravalvular leak. Rarely clinically significant with modern devices.

Long-term Durability

Surgical valves have 20+ year follow-up data. TAVI valves have 10-year data showing excellent durability; longer-term data accumulating.

Pacemaker Requirement

TAVI: Higher pacemaker requirement (10 to 20%) due to conduction system disruption. Surgery: Lower (2 to 5%).