Country's first valve replacement minus open heart surgery

The aortic valve lies between the left ventricle of the heart and the aorta, and a problematic valve can obstruct the blood flow out from the heart.

The ailment then needs to be corrected through a replacement of the valve -- a procedure that hitherto had no option but surgery in India -- leaving the patients who are deemed high-risk for surgery with no alternative procedure to save their lives.

But a group of doctors in Medanta Medicity, Gurgaon, are set to perform the first percutaneous valve replacement in India that comes minus an open heart surgery, and hence cuts the risks associated with it for very old people and those considered high-risk with lung or kidney ailments.

"Uptil now there was no alternative or replacement to surgery for aortic valve defects and we were unable to treat patients in whom surgery was not possible," says Dr Praveen Chandra, chairman of interventional cardiology at Medanta Heart Institute.

In the procedure called Percutaneous Aortic Valve Implantation or PAVI, a valve is taken through a stent inserted inside a small opening made in the groin.
The artificial valve is then taken through lower limb blood vessels to the heart where it is fitted under X-ray vision.

"The procedure takes one hour and the patient can be discharged in 3 to 4 hours, unlike in a full fledged surgery which takes at least 4-5 hours and requires some three months for the patient to fully recover," he said.

The procedure will be performed next month by a group of doctors from the hospital with some six surgeons from Europe, who are well-versed with the procedure, assisting them.
"Existing procedures have their own role and utility, but there are limitations for patients who are quite old and frail, and we are not able to remove their aortic blockage through surgery. For patients who can't take a major operation, it is a crucial alternative," says Dr Naresh Trehan, Chairman of Medanta Medicity.

The procedure is done in a fashion similar to angioplasty, with a small puncture in groin vessels with or without anaesthesia depending on the condition of the patient.
The procedure is an evolving one and experts say there is limited data available about it, given the fact that experience available on the subject is less.

Another disadvantage is its high cost. The procedure will cost Rs 12 lakh as against the surgical procedure where patients need to spend Rs three lakh roughly.

"We believe over a period of time when experience and popularity of the procedure grows, costs will get lesser. And once Indian surgeons become well versed in the practice, we will not need to fly in experienced foreign doctors, the way we are doing it now," Chandra says.

The procedure is still very young and its inception is traced backed to the year 2000. Since then, a total of 10000 percutaneous aortic valve implants have been done worldwide with more than 95 per cent success rate.

Chandra says patients are being enrolled and screened to test their suitability for it as they await clearance from the government for the surgery being performed for the first time in the country.