First Case in the World, TAVR + PTCA
By Dr. (Prof.) Purshotam Lal in Cardiology Interventional Cardiology
Sep 14, 2017
First breakthrough Non-Invasive Surgery at Metro Hospitals & Heart Institute, Noida created a world record Transcatheter Aortic Valve Replacement (TAVR) + Angioplasty with Stenting (PTCA) done by PADMA VIBHUSHAN & Dr. B C Roy National Awardee Dr. Purshotam Lal, Director – International Cardiology & Chairman – Metro Group of Hospitals
- The open heart surgery, which normally takes 4-5 hours, was successfully done in less than 45 minutes without surgery
- This was the first breakthrough to perform hybrid procedure on a 76 years old female involving angioplasty with stenting of the major artery along with transcatheter aortic valve replacement (TAVR) by using unique innovative pre-crimped, pre-loaded, pre-packaged ready to use self expandable Aortic Valve.
- The revolutionary procedure will require less learning curve and will be easy to perform thus making a boon for the elderly patients who are at high risk for open heart surgeries
30th November, 2016:
Metro Hospitals and Heart Institute, Noida created a world record when a revolutionary non-surgical procedure for heart, Trans Cathether Aortic Valve Replacement (TAVR) was done successfully on a 76 year old patient in less than 45 minutes along with Angioplasty with Stenting of the main artery in the same sitting.
Introduction
Aortic stenosis is the narrowing of the aortic valve of the heart which restricts the blood flow to the whole body. It is one of the most common and most serious valve disease. Patients usually complained breathlessness, chest pain, fainting etc. It mainly affects older people due to scarring and calcium built up and usually starts after the age of 60 but does not shows symptoms until age of 70 or 80. More than one in eight people over the age of 75 may have moderate or severe aortic stenosis. Since we are seeing more and more elderly patients, its condition may become an important public health problem. The mortality rate is almost 50% in the first two years after the symptoms among the untreated patients. In clinical practice atleast 30% of patients with severe symptomatic aortic stenosis do not undergo surgery for replacement aortic valve, owing to advanced age or presence of multiple co-existing conditions. This group of patients who are either unfit for surgery or at high surgical risk, a less invasive treatment like Transatheter Aortic Valve Replacement (TAVR) is a big blessing.
Background
In 1992 while presenting the oration lecture at the annual function of Cardiological Society of India at New Delhi, Dr. Purshotam Lal presented animal studies of Transcatheter Aortic Valve Replacement (TAVR) and made a statement that “one day we will do Aortic Valve Replacement without surgery”. Though Interventional Cardiology made a tremendous progress by that time but everybody was skeptical about the success of this procedure. 12 years after on July 12, 2004 Dr. P. Lal along with his team performed the Transcatheter Aortic Valve Replacement with Core Valve for the first time in the world and published the research paper on the same. Since then Dr. Lal has been invited by different countries to present the first case of the world of Aortic Valve Replacement with Core Valve. The procedure became so popular around the world that till today about 2 lac cases have been performed in different countries. Currently the Core Valve is being provided by Medtronic and cost about for one procedure 16-20 Lacs which is not possible for a common man to afford. More than 20 different kinds of valves are in clinical use and hopefully the cost will come down due to competition.
Our Case Report
Our patient Mrs. Rama Dhamani, 76 yrs. old female having past history of hypertension since 15 years, hypothyroidism since 10 years, COPD (bad lung), severe osteoarthritis of both knees. She has been complaining severe difficulty in breathing and chest pain and has been hospitalized many times with heart failure. Her Echocardiography showed severe and Calcific Aortic Valve Stenosis. Her Coronary Angiography revealed critical block of its main artery. Neither this patient was fit for surgery nor was the family ready for open heart surgery at any cost. To the extent when we took her in Cath Lab, family told us categorically that we are not ready even for emergency surgery in case you require for some reason on during the procedure. The procedure was done under local Anaesthesia from the groin area like any other angiography procedure. Initially Angioplasty with Stenting of the main artery was performed followed by 26 mm size pre-crimped self expandable valve. Post procedural Angiography and ECHO study showed no leak or tightness in the valve and the patient was sent home after three days. Now the patient has come for three weeks follow-up and is doing well. We are planning for her bilateral knee replacement in the near future which otherwise would not have possible.
Venibri Aortic Valve System has been developed by Colibri Heart Valve System based in Broomfield, Colorado, USA and Venus Medtech at Hangzhou, China. It is a pre-mounted, pre-crimped and pre-packaged, ready for use self expandable Transcatheter Aortic Valve Replacement (TAVR) device. In this new ready for use system, the valve is extremely strong, durable and made of bio-compatible tissue which enables crimping, loading and packaging of the valve at the time of manufacturing itself. This new system which will involve less learning curve and will take much less time for the procedure and takes only 15 minutes from taking the ready for use catheter loaded with the valve to its deployment.
This particular procedure of combination of innovative pre-crimped self expandable, ready to use valve Replacement along with Angioplasty with Stenting of the main artery makes this the first procedure of its kind in the world.
“It was difficult and scary time for me as my health was deteriorating each passing day and there was no option but to live with it. I was not fit to have the open heart surgery due to my age and other health problems. But my hopes were rekindled when I learned about the possibility of having the procedure without the surgery and minimal complications involved. I had my health back after having the treatment successfully,” said Mrs. Dhamani after undergoing the non-invasive procedure at Metro hospital.
