Heart Valve Replaced without Open Surgery for First Time in Kerala at Amrita Institute of Medical Sciences

A 67-year-old woman, Amaloor Pavam, underwent a rare medical procedure at the Amrita Institute of Medical Sciences (AIMS) to repair the damaged aortic valve of her heart without opening of the chest. The non-surgical procedure, called Transcatheter Aortic Valve Implantation (TAVI), was performed by a team led by Dr. C. Rajiv, Professor of Cardiology, AIMS, Kochi.  The team performed this procedure for the first time in Kerala.

Dr. M. Vijayakumar, Professor of Cardiology; Dr. Abraham Cherian, Head of Anesthesia; Dr. Reshmi; Dr. Balasubramaniam; Dr. Ashish; Sree Lakshmi, Chief Technologist; and Rose Sophie, Nurse-in-Chief, were part of the team which performed the procedure.

The patient, who suffers from diabetes and hypertension, had undergone surgical replacement of the aortic valve with a tissue (bio-prosthetic) valve 11 years ago. With time, she again developed severe obstruction of the tissue valve and had to be admitted twice at AIMS for heart failure.

Amaloor was offered the new treatment of TAVI by AIMS doctors because of its many benefits over a repeat conventional valve surgery, which was thought to be risky in her case. The old damaged valve was not removed from her heart. Instead, a new replacement valve was wedged into its place. Since the new valve was inserted through blood vessels by making a small incision in the patient’s groin, there was no need for open-heart surgery.

Amaloor is doing well and has been discharged from the hospital after the procedure was successfully performed. She first came to AIMS in January this year. She was breathless even at rest and had swelling of feet. She was twice admitted at the hospital for management of heart failure. Her valve had narrowed critically and a valve replacement was considered mandatory for her survival. 

Said Dr C. Rajiv, Professor of Cardiology, AIMS, Kochi, "With TAVI, there is no need to stop the heart through heart-lung bypass, or open the chest surgically. The morbidity associated with these procedures is drastically reduced because TAVI is minimally invasive. Moreover, it takes only 30-45 minutes for implantation of the new valve. This procedure is now used in Europe and US for patients at high risk for surgical aortic valve replacement. This is the first instance of TAVI procedure being conducted in Kerala. TAVI is likely to gain wide acceptance and may be offered even in patients at moderate risk for surgical replacement in a few years."

Aortic valve diseases affect about 2% of all people above the age of 65. When the aortic valve fails, it is often replaced with a bio-prosthetic valve made of animal tissue. However, this valve is also prone to failure over a time period of 10 to 15 years. The second surgery needed to correct this is associated with increased morbidity and mortality.

In humans, blood flows out of the heart into a large blood vessel called the aorta. The aortic valve separates the heart from the aorta. When the heart contracts, the aortic valve opens and the blood flows out. It then closes, when the heart relaxes, to keep blood from returning to the heart. People need aortic valve surgery if the aortic valve does not close tight, so blood leaks back into the heart (aortic regurgitation), or when the aortic valve does not open well enough, due to which the blood flow out of the heart is significantly reduced (aortic stenosis).

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