TAVI performed with avant-garde self- expanding valve EVOLUT FX gave a new lease of life to a 74-year-old patient.

About The Patient And Condition

A 74-year-old male patient presented at Apollomedics Super Speciality Hospital, Lucknow, with a past history of hypertension and SDH. The patient was diagnosed with severe symptomatic aortic stenosis (NYHA III).

Case Scenario

During a detailed evaluation, his blood chemistry was normal except for serum creatinine being 1.5 mg/dl. ECG revealed LVH (Left Ventricular Hypertrophy). Echo study showed Severe Calcific Aortic Stenosis with Vmax- 3.9m/sec & mean PG – 42mmHg with normal LV function. After total evaluation the Intervention Cardiology team decided to go for TAVI (Trans Aortic Valve Implantation) which was best suitable for the patient, given his condition.

CT coronary and aortogram was done according to TAVI protocol which revealed Bicuspid Type 1A Aortic valve with severe Aortic valve calcification which extended into LVOT (Left Ventricular outflow tract obstruction) from all coronary cusps. This was a complex TAVR case because of high calcium around annulus, leaflet and LVOT. So, there were high chances of Annular Rupture and conduction disturbances during the procedure. The valve used in the procedure was a self-expanding valve-EVOLUT FX which was a first in Uttar Pradesh.

Post procedure, the patient developed intermittent CHB (Complete heart block) which was anticipated & hence a PPI (Permanent pacemaker) was implanted. The post op Echo showed no residual gradient across the valve. The patient was discharged in a healthy state on 2nd post op day and remained asymptomatic during follow up.

Worldwide Scenario

Aortic Stenosis is an age related degenerative disease with a high mortality if not treated It is the most common acquired valvular heart disease with a prevalence of 2-4% in subject over age of 65% years. In India isolated Aortic Stenosis is the 3rd most common (7.3%) valve lesion in adult population. Degenerative calcification is the most common cause (65%) followed by bicuspid valve (33.9%) while rheumatic heart disease contributes to 1.1%.

Although SAVR is a class I recommendation for severe Symptomatic AS according to ACC/ AHA guidelines, nearly 1/3rd patients are unable to undergo SAVR because of comorbidities, frailty, left ventricular dysfunction and advanced age, in which TAVR is now the class I recommendation.

Expertise At Apollo Hospitals

Dr Gautam Swaroop is Senior Consultant Cardiologist at Apollomedics Super Speciality Hospital, Lucknow. He has expertise in treating different types of complex heart conditions. Our hospital is equipped with all the latest facilities to help the doctors perform such complex surgeries with safety.

Patient Testimonial

The patient is extremely thankful to Dr Gautam Swaroop, Department of Cardiology at Apollomedics Super Speciality Hospital, Lucknow for the TAVI procedure with a phenomenal outcome.