Transcatheter Therapies – Adding Years to Life and Life to Years

While India is usually considered a young country with half the population being below 25 years of age, it is predicted that by 2050, our senior citizens will treble in number, with 434 million under the ‘oldest old’ category (aged above 80 years).

As we age, the wear and tear of different valves of the heart only increase. For instance, the aortic valve opens when the heart contracts to allow blood to pass from the left ventricle into the aorta, the body’s main artery. When this valve begins to get narrow, it restricts blood flow creating a serious and potentially life-threatening condition that is called aortic stenosis.

Every year we diagnose more than a million cases of aortic stenosis in India. It is estimated to affect 1 in 8 people over the age of 75. It also has a higher mortality rate than most cancers, patients have astounding mortality of 90% in 4 years if left untreated.

Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve implantation (TAVI) is a minimally invasive procedure that is performed on a beating heart and does not require cardiopulmonary bypass. Nor does it require “blood thinners”. Instead, revolutionary valves, constructed from a combination of metal mesh & animal tissue, are delivered via a thin tube (catheter) usually through the femoral artery and then expanded in place.

A vast variety of cases have been treated very successfully with TAVR including 90-year-olds — with severely damaged valves, 2-leaflet aortic valves and even surgically replaced aortic valves that have failed.

Another condition that commonly presents itself in senior citizens is mitral regurgitation. Here the heart’s mitral valve leaflets do not close tightly and as a result, blood keeps flowing back in the wrong direction. The heart must then work harder to push this blood through the body, which can cause fatigue, shortness of breath and even heart failure.

The MitraClip (another — trans-catheter therapy) repairs the mitral valve by clipping its leaflets together. This drastically improves outcomes in patients, lowering hospitalizations and improving their quality of life with fewer symptoms. It has been used in over 50,000 patients from across the world to date. Introduced in India last year, this revolutionary procedure is now treating leaking mitral valves in critically-ill, and inoperable heart failure patients giving them a second lease of life.

At 86, Mrs. Saradhal Alagappan is also India’s oldest patient to receive the MitraClip on India’s maiden run. She had torn a chord that was essential for her mitral valve function causing the valve to leak heavily pushing her into heart failure. Her symptoms were so severe that over the past year she had been hospitalized 6 times and was confined to a wheelchair due to shortness of breath. She was refused surgery due to her age and frailty and medication was no longer able to control her symptoms. Now after MitraClip Therapy, she is enjoying badminton rallies with her grandchildren.

Dr. Sai Satish

MD, DM

Sr. Consultant Interventional Cardiology,

Apollo Hospitals Group,

Apollo Hospitals, 21 Greams Lane,

Off Greams Road, Chennai – 600006