Transcatheter aortic valve implantation or TAVI is a new non-surgical procedure in which the aortic valve can be replaced without major open-heart surgery. Aortic valve is one of the four valves in the heart. This valve located on the left side of the heart facilitates the forward flow of oxygen-rich blood from the heart to the aorta and thereafter to other parts of the body. Degenerative Aortic stenosis is a disease of the elderly where the surgical risks would be prohibitively high. In this procedure, the valve is accessed through an artery in the leg. It’s a boon for the octa-nonagenarians who till now had to choose either to go in for a high-risk open-heart valve replacement surgery or a curtailed life.
While this therapy is established as the standard of care in the west, there are few challenges for this therapy in India. For the TAVI procedure, there is knowledge, attitude, and practice gap because of which the procedure has failed to gain acceptance. TAVI is being used in the west for more than a decade and has undergone the rigors of carefully conducted medical trials and approval by the stringent USFDA norms. Large-scale trials have shown that TAVI is safer and more efficacious in a high-risk subset of patients. Recently, USFDA has given approval even for low-risk subsets after the result of a few landmark trials. Unfortunately, the knowledge of TAVI as an established form of treatment- even among medical colleagues is dismal. Most think of it as some sort of experimental procedure, which is not true. The procedure required specialized training, practice, and a qualified team of interventional cardiologists, anesthetists, and nurses. Even in a megapolis like Mumbai, a handful of interventional cardiologists are certified to do this procedure independently. The pandemic also played a role as many international proctors (Trainers) couldn’t travel to Mumbai. Likewise, Indian cardiologists couldn’t go abroad or have workshops in the country due to restrictions. But things are looking up now as more and more independent TAVI operators are growing in Mumbai and suburbs Another hindrance due to which the procedure has not found wider application is the cost. The average cost of the entire procedure ranges from 19 to 28 lakhs depending upon the valve used, the procedural fees levied by the surgeon, and the hospital setting. This makes TAVI out of reach of most Indians. Many insurance companies don’t provide cashless facilities or reimbursement for the entire cost of the procedure.
The challenges are multiple but the gaps in further wider acceptance should be addressed to make it available to those who need it the most.
Dr. Ankur Phaterpekar,
Consultant Interventional Cardiologist ,