There is a wide range of cardiac diseases such as valvular heart disease, congenital defects and heart failure that can be treated without doing the traditional open-heart surgery.

A less-traumatic alternative to the traditional open-heart surgery, minimally-invasive structural heart interventions have made significant advances in the last few years. Interestingly, there is a wide range of cardiac diseases — such as valvular heart disease, congenital defects and heart failure — that can be treated with this approach. Dr Haresh G Mehta, director-interventional cardiology and Dr Kayan Siodia, consultant interventional cardiology, S L Raheja Hospital, Mahim — a Fortis associate say that for patients with valvular heart disease, valve replacement or repair through open heart surgery was the only option, which had a “high procedural risk” and longer recovery time.

Some recent innovations

According to the doctors, with the emergence of transcatheter aortic valve replacement (TAVR), transcatheter Mitral valve replacement (TMVR), transcatheter tricuspid valve replacement (TTVR) and percutaneous Mitral and tricuspid valve repair, any heart valve can be replaced using a catheter — a small tube inserted through the leg that goes to the heart, through which the valve is deployed.

Transcatheter aortic valve replacement (TAVR)

Severe aortic valve stenosis, for instance, is an age-related degeneration of the aortic valve due to calcium buildup which, if left untreated, can cause heart failure and death. TAVR has revolutionised its management in patients, in whom the aortic valve can be replaced by an ‘entirely endovascular approach’.

“This has especially been life-saving for patients with multiple comorbidities — diabetes, hypertension, chronic renal failure, airway disease — who are at a higher risk of complications with open heart surgery. With TAVR, they are able to have a faster recovery, requiring less hospital stay; most patients get discharged on the next day itself,” said the experts.

MitraClip technology

Similarly, severe Mitral valve regurgitation (a leaky valve) is common in younger patients with ‘myxomatous Mitral valve degeneration’, and in those with chronic heart failure. For them, transcatheter repair done using MitraClip technology has been a ‘gamechanger’.

“Often, patients with atrial fibrillation develop bleeding due to blood thinners. For them, percutaneous left atrial appendage device closure can be done, and blood thinners stopped thereafter. These patients previously needed something called ‘left atrial appendage ligation surgery’. In patients with end-stage heart failure needing heart transplant, percutaneous ventricular assist devices have the potential to improve survival and quality of life,” said the doctors.

Benefits of these new catheters-based structural heart interventions

• They are less invasive
• There is no surgical scar
• The procedure time is short
• Shorter recovery time
• Shorter hospital stay
• Can be done for patients with multiple comorbidities
• Can be done on patients at high risk for surgery