62-years-old, women (Kusum Gautam) from Satna, M.P. came to Dr. Nitin Tiwari, Sr. Interventional Cardiologist at Wockhardt Hospitals, Shankar Nagar, Nagpur with a history of shortness of breath, difficulty in lying down, palpitations, and chest discomfort. On examination, Dr. Nitin Tiwari (Sr. Interventional Cardiologist) diagnosed that patient had severe aortic stenosis with decreased pumping of heart and heart failure. She had recurrent breathlessness for which a Non-invasive ventilator was put and had recurrent irregular heartbeats for which injections were started. She had episodes of low blood pressure also which were treated. The patient had closely survived death at least 5 times.
After seeing her critical condition and grim chances of survival, Dr. Nitin Tiwari decided after 2D Echo & CT Scan that the lady requires TAVI (Transcatheter Aortic Valve Implantation) which is an interventional procedure just like angioplasty in which a crimped valve is put in the aortic position through a small puncture in the groin without major surgery or incisions on the chest.
On August 29, 2020, the Myval TAVI valve was deployed by Dr. Nitin Tiwari and his team with excellent results. The lady’s parameters improved immediately and her pumping of the heart also improved from 25 % to 42 % in 2 days.
Aortic stenosis (AS) is the most common degenerative valvular heart disease in the developed world. It affects about 2 % of people who are over 65 years of age. In those who have symptoms, without repair, the chance of death at five years is about 50 % and at 10 years is about 90 %.
The survival decreases drastically in a patient with AS after the onset of heart failure. The average life expectancy is about 2 years after the onset of heart failure. The incidence of sudden cardiac death is higher in symptomatic severe AS ranging around 34 % when compared to asymptomatic severe AS 1 %. Hence symptomatic severe AS patients are prone to develop sudden cardiac arrest during hospital stay awaiting aortic valve replacement and are also difficult to revive. In acutely decompensated severe AS, emergency TAVI is feasible which can be performed quickly with experience.
Apart from Rheumatic heart disease and Bicuspid valve the risk factors for developing AS are similar to those of coronary artery disease and include smoking, high blood pressure, high cholesterol, diabetes, and being male.
What happens during TAVI?
It is performed in the Cath Lab. Depending on your health; the doctor will determine what type of anesthesia is best for you. You may be fully asleep, or you may be awake but are given medications to help you relax and block pain. Your heart will continue to beat during the procedure. This is quite different from open-heart surgery, in which your heart will be stopped, and you will be placed on a heart and lung blood machine.
Dr. Nitin Tiwari thanked his team especially, Mrs. K. Sujatha, (Centre Head, Wockhardt Hospitals), Dr. Maulik, Dr. Awantika Jaiswal, Dr. Jayaprasanna, Dr. Atul Somani, Dr. Kunal Balpande, Mr. H. Munde, Mr. Raut, Dr. Devendra, Mr. Amit Mukherjee, Mr. Mohit and all others who contributed in the success of the procedure.
Dr. Nitin Tiwari is the first Cardiologist from Nagpur to be formally trained to do TAVI at Klinikum Oldenburg, Germany, where under Dr. Elsasser, he performed around 8 TAVI’s. TAVI’s being done in Wockhardt Hospitals, Nagpur is a good sign said Dr. N. Tiwari, and the patients no longer need to go outside Nagpur for this procedure although the cost still remains high, with more acceptance, it is bound to come down.