Complex heart valve replacement surgery gives new life to farmer

Amidst the Covid-19 pandemic, first of its kind Transcatheter aortic valve replacement (TAVR) was performed at Sir HN Reliance Foundation Hospital to save a 62-year-old farmer who was brought to the hospital with heart failure.

The special type of TAVR, which is Valve-in-Valve procedure was performed within 4 hours of the patient’s relatives and doctors agreeing for the procedure.

The Mumbai resident, was brought to Sir HN Reliance Foundation Hospital (Sir HNRFH) on the evening of June 20 gasping for breath. Initial assessment showed he had very low blood pressure, no urine output and swelling all over the body, suggestive of severe heart failure.

“When we assessed the patient in our emergency ward, we knew he had severe heart failure because of dysfunction of one of his artificial heart valves that was implanted with an open heart surgery six years ago. He was immediately put on dialysis and multiple medicines to support his dropping blood pressure levels,” said Dr Maulik Parekh, cardiologist at Sir HNRFH, who headed the medical team for TAVR.

He said while the medical team were sure that the patient needed a valve replacement, a repeat open heart surgery was considered to be extremely high risk because of his critical condition and previous surgical history. Hence, we offered the Transcatheter Aortic Valve Replacement (TAVR) as a safer alternative.

“TAVR is a complex minimally invasive cardiac procedure to treat severe narrowing (stenosis) of aortic valve (valve between heart and the main blood vessel). Once the patient’s relatives gave a go ahead, within a short time of 4 hours, the patient was taken up for the procedure” said Dr Parekh.

As it is well known, TAVR is a planned/elective procedure. To organise a TAVR procedure, it takes 15-17 days which involves a battery of diagnostic tests, planning of team of doctors, deciding on right size of the valve etc.

The planning of TAVR was a herculean task as the patient was critical and was not fit for a CT scan that is required to find the right size of the valve. With his deteriorating health, it was a race against time to arrange logistics for ordering the right size of the valve in short time.

In this patient’s case, luckily he had undergone angiography a week before he was brought to Sir HNRF, which further helped the doctors to judge the exact type and size of the previously implanted valve and place the request for the appropriate valve for him.

In the hour long procedure, cardiologists inserted a new valve inside the previously implanted valve which had failed without opening the chest. “I am happy that we decided and managed to do the procedure within 4 hours of the decision. For this patient, TAVR turned out to be lifesaving procedure. Within two hours of the procedure, all his vital parameters came in control. He was discharged on July 2,” said Dr Parekh.

Vitthal Kadam’s nephew Sanjay Kadam said it was a rebirth for his uncle at Sir HN Reliance Foundation Hospital. A doctor himself by profession, Sanjay Kadam said, “My uncle is leading an absolutely normal life. Today, if he is alive with us, it is because of doctors at Sir HN Reliance Foundation Hospital. Being a doctor, I know it was next to impossible to save my uncle. They were thinking to do a bypass but the team decided, and we consented to go ahead with TAVI. My entire family is indebted to entire team at Sir HN Reliance Foundation Hospital for saving my uncle’s life.”

In the lockdown, this was the third case in TAVR in Sir HN Reliance Foundation Hospital. The earlier ones were planned procedures and all the patients are doing well. Sir HNRFH is a centre of excellence for this particular type of surgery since it boasts of a proctor-free interventional cardiology team, which has the most experience for this procedure and a hybrid cathlab, which is ideally suited for such interventional surgeries.

Team of doctors included Dr. Maulik Parekh (TAVR expert, Proctor), Dr. Anvay Mulay (Surgeon) , Dr. Manoj Mashru (Cardiologist) , Dr. Ajit Menon (Cardiologist), Dr Pravin Kulkarni, Dr Talha Meeran, Dr Niranjan, Dr Himanshu, Dr Bhavesh Vora.