Here's what you need to know about the latest in on-surgical heart treatments

Aug 30, 2017

Quick Bites:
  • TAVR is a technique to replace one of the valves of the heart without ‘open heart surgery’. 
  • When arteries of the heart get blocked by cholesterol deposits, heart attacks can occur. 
  • In Renal denervation therapy, the patient is fine to walk and be discharged on the next day. 

Hear it from the pioneer of these new treatments in India.

Treatment of heart disease has evolved a great deal in the past decade. Dreams of the past are becoming a reality today. Whether it’s a damaged heart valve or a blocked artery, you can expect the safest option involving least trauma and best results. Some of these include:

Transcatheter aortic valve replacement (TAVR)

This is a technique to replace one of the valves of the heart without ‘open heart surgery’. The heart is a muscular pump which pumps oxygenated blood to all parts of the body including liver, kidneys, brain. The ‘aortic valve’ allows blood to flow only in one (forward) direction. Due to defect of this valve from birth or because of ageing, this valve may develop calcium deposits that narrows it and restricts it from opening fully. This stops blood from passing through to the brain and the rest of the body--a condition known as ‘aortic stenosis’. Aortic stenosis affects nearly 4-5% of old people and once severe leads to death in most within 2 years. Till recently, the only way to replace this valve with a new one was through a major surgery which involved stopping the heart, putting the patient on a ‘bypass pump’ and cutting open the heart to put in a new valve. Now, in one of the biggest breakthroughs in medical science, this can be done non-operatively through a puncture in the groin, in the cath lab in an angioplasty-like procedure. The procedure lasts for approximately two hours. Also, because it’s non-surgical, it is safer and the patient can be discharged in three to four days. It’s particularly recommended for seniors whose age makes surgery a risky affair. Recently we used this technique for the first time in India to successfully treat three patients (aged 71, 72 and 80).  These patients had severe aortic stenosis, had been refused surgery because of high risk and if not treated could have died over next two years.  All three recovered rapidly and are now leading a normal life with full activities.

Bioabsorbable stents

When arteries of the heart get blocked by cholesterol deposits, heart attacks can occur. One of  the widely used and successful treatments of coronary artery disease involves angioplasty where small stainless steel spring like devices coated with a drug called ‘Drug Eluting Stents’ are inserted into the arteries to remove the blockage and keep the arteries open. But, having a piece of metal in the heart arteries throughout the life has some disadvantages including the fact that the patients have to be on blood thinning tablets throughout life.  There are now ‘stents’ which are made of a certain plastic like material which after doing their job of opening up the heart arteries gradually dissolve and disappear in about two years leaving the artery totally normal. This fascinating and revolutionary treatment was first used in India at Fortis Escorts Heart Institute in October, 2010 as a part of a study. The bio-absorbable stents are expected to be in regular use from next year and may do away with the need to take long term blood thinners.

Renal denervation therapy

Another new treatment around the corner is a procedure of Renal Denervation Therapy, where in a brief non-operative angioplasty like procedure the nerves to the kidney are interrupted by microwave catheter. The patient is fine to walk and be discharged on the next day. The procedure leads to better control of uncontrolled blood pressure. The procedure is expected to be a one time cure of high B.P. It may also end the lifelong need for B.P. medications.

The contributor, Dr. Ashok Seth is Chairman, Cardiac Sciences at Fortis Escorts.

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