Day 1 Awake Aortic valve replacement under local anesthesia
Day 1: After 9 Hours of Valve replacement
Day 3: Discharge without a single stitch on body
Transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), is the replacement of the aortic valve of the heart through the blood vessel without open-heart surgery. The replacement valve is delivered by a transfemoral approach ie groin like Angioplasty.
Severe symptomatic aortic stenosis carries a poor prognosis with a life expectancy of 2 to 5 years after diagnosis. Until recently, surgical aortic valve replacement was the standard of care in adults with severe symptomatic aortic stenosis. However, the risks associated with surgical aortic valve replacement are increased in elderly patients and those with concomitant severe systolic heart failure or coronary artery disease, as well as in people with comorbidities such as cerebrovascular and peripheral arterial disease, chronic kidney disease, and chronic respiratory dysfunction.
The first implantation in a patient was performed in 2002 on April 16 by Alain Cribier in Hospital Charles Nicolle, at the University of Rouen
This therapy got USFDA approval in 2011, two major companies which manufacture Valve is Edwards’ Sapien aortic valve is made from bovine pericardial tissue and is implanted via a catheter-based delivery system and Medtronic’s CoreValve Transcatheter Aortic Valve is constructed of a self-expanding Nitinol frame and delivered through the femoral artery. This device received FDA approval in January 2014.
Indian manufactured MyValve is CE approved and Indian DCGI approved from Meril Lifesciences, it started with the Pilot study in India 2017, following which it got DCGI approval, It is available for commercial use since 2018. To date, this 400 numbers of valves are deployed in India and abroad. My valve has received great recognition in Europe and the middle east due to its smooth deliverability and lesser adverse events.
Ruby Hall clinic has delivered such 3 TAVR valves till now, but Young cardiologist Dr. Rahul Patil, Interventional cardiologist, Ruby hall clinic, Pune did this procedure as primary operator along with Proctor Dr. Anmol Sonawane and associate Dr. C N Makhale, Dr. Bikas Sahoo cardiac anesthetist on 13/10/2019 Sunday at 10 am in a 65-year-old Mr. Bashir shaikh from Pune. This procedure was done under local anesthesia in the awake state of the patient during procedure like routine angioplasty. The procedure time was 1 hour only. Dr. P K Grant congratulated the team of Dr. Rahul Patil for his excellent work.
The patient was mobilized after 9 hours, shifted from CCU after 24 hours and discharged on 3 rd day of procedure.
As a conventional Surgical aortic valve replacement, the patient has to undergo open-heart surgery on heart-lung machine where operation time is 4 hours, it involved 10 to 12 % of Morbidity and mortality. Patient has to kept on Ventilator for 24 hours, Patient remains in surgical ICU for 4 days, and total hospitalization for 10 days. It takes 3 weeks for complete healing of stitches over the chest wall, and 2 to 3 months for sternal fracture healing. This procedure also involves the risk of embolic brain stroke in 5 to 6 %of patients.
Today, TAVI is recommended not only in high surgical risk patients but also in moderate to low-risk patients.
Dr. Rahul Patil has been trained in the Netherlands for TAVI in 2009 and now he owes promise to all his high-risk heart valve disease patients who can be treated without undergoing open-heart surgery.
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