TAVI, the game changer in heart surgery | Daily News

TAVI, the game changer in heart surgery

Dr. Paul Chiam
Dr. Paul Chiam

If you need to have a heart valve replaced or implanted, having to undergo an open heart surgery is a daunting thought, especially when you know the potential risks and complications of an open heart surgery which also takes longer to heal.

The risks are always greater if the open heart surgery needs to be performed on an elderly or a diabetic patient or on someone with existing medical complications. In such an instance, what options do patients have? Should they risk an open heart surgery or take a chance on time decidingone’sfate? A dilemma one would never want to be confronted with.

According to Dr. Paul Chiam, Senior Consultant Cardiologist at Singapore’s Mount Elizabeth Hospital and Adjunct Associate Professor at the National University of Singapore, it is no longer a life threatening dilemma that one needs to worry over. He says that advancements in technology have enabled a simple solution to a potentially complicated scenario through a technique called transcatheter aortic valve implantation (TAVI) or also known as Transcatheter Aortic Valve Replacement (TAVR).

“TAVI procedure can be performed with lower risks in many complicated situations such as elderly persons, diabetic persons and even those with multiple medical conditions or those with higher or medium risks for surgery such as patients with poor heart function, severe lung disease and kidney failure or those considered inoperable,” Dr. Paul Chiam said.

Valve replacement is necessary when the aortic valve which regulates blood flow from the heart to the rest of the body is narrowed.The aortic valve is like a one-way gate that regulates blood flow from the heart to the rest of the body. The valve opens to allow the heart to pump blood to other organs, and closes to prevent blood from flowing backward into the heart.With ageing, the aortic valve may become narrowed, in a condition known as aortic valve stenosis. When the narrowing becomes severe, patients develop breathlessness, fainting spells and chest discomfort due to a lack of oxygen-rich blood. If left untreated, the disease can be deadly, with up to 50 percent of patients dying within two years.

“TAVI is a game changer in heart surgery,” Dr. Chiam says .It is a technique ideal for intermediate or high risk patients, as it inserts a catheter to a blocked valve without opening your chest or stopping your heart. It is a minimally invasive method where a small incision is made in the groin, and a new valve is delivered through a catheter (or a tube) into the heart and implanted within the patient’s native aortic valve.

Traditionally, doctors have performed open heart surgery to implant a valve, but open heart surgery has many risk factors that the TAVI procedure has managed to overcome.

“Unlike open heart surgery, the patient undergoing TAVI does not need the chest cracked open, the heart is not stopped when implanting the transcatheter heart valve onto the beating heart, the native aortic valve is not removed and the newly implanted transcatheter valve does not need to be stitched in place. The groin approach procedure can also be done under local anaesthesia,” Dr. Chiam said.

“Because there is no wound to heal under TAVI, recovery is faster. In our experience, recovery period is 2-3 days whereas open heart surgery would require several weeks. There is no pain and no scar. Also the potentialto contract any infections or complications after the surgery is low. The procedure can be done with local anesthesia as well,” he said.

Having performed Asia’s first transcatheter aortic valve replacement (TAVR) procedure in 2009, and hundreds of TAVI procedures thereafter, Dr. Chiam is confident that compared to an open heart surgery TAVI is better for the patient. It is estimated that more than 500,000 TAVI implants have been done worldwide, changing the paradigm in the treatment of aortic valve stenosis.

Studies have shown that inpatients who underwent TAVI via the groin approach there was a lower rate of disabling stroke or death, and was thus better than open heart surgery.

Nonetheless, Dr Chiam qualifies that although the risk of stroke associated with TAVI is similar or lower than open heart surgery, there remains significant absolute risk of stroke at 2-3%, as with any heart surgery.

According to him, in Singapore patients are better aware of the benefits of this and are opting to undergo a TAVI procedure versus an open heart surgery. Everey year in Singapore, upto 120 TAVI procedures are conducted. The trend in opting for TAVI is increasing in Asian countries but with few hospitals in Asia offering this procedure option, many patients are left relying on surgery or medication or time as a determinant of their fate.

Singapore’s Mount Elizabeth Hospital is one of the first hospitals to embrace the technology and to offer patients TAVI. With an experienced team, doctors at the Mount Elizabeth hospital are well equipped and trained to successfully complete this procedure as well as for after procedure care.

A common misconception is that TAVI procedure is costly, but compared to the monetary costs of surgery and hospitalization and health costs of after effects and prolonged recovery of an open heart surgery, TAVI may actually be a more cost effective option. - SP 


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