Sir H. N. Reliance Foundation Hospital, has a Centre for Holistic Management for Valvular Heart Diseases.
Heart diseases are the most common cause of death in developing and developed countries. Heart valve disease form a significant portion of the overall heart diseases spectrum. The prevalence of heart valve disease increases with age. According to an estimate, 6.4% of population over the age of 65 years have moderate or severe symptomatic valve disease. Therefore, as life expectancy improves, the prevalence of valve disease is likely to increase with a resultant increase in the burden of valve disease.
It is often observed that patients receive diagnosis and intervention late in the course of disease and often do not get referred at all despite having symptoms and need for immediate intervention and treatment. The Euro Heart Survey found nearly one-fifth of patients with aortic stenosis (narrowing of the aortic valve of heart) undergoing intervention had reduced left ventricular ejection fraction (<50%), which could have been prevented by timely diagnosis and treatment. Hence it is of paramount importance that a dedicated centre and team looks after the timely and guideline based diagnosis and management of valvular heart diseases.
Objectives of the dedicated centre of excellence for valve disease –
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). Transcatheter aortic valve replacement is sometimes called Transcatheter aortic valve implantation (TAVI). TAVR may be an option for people who are considered at intermediate or high risk of complications from surgical aortic valve replacement. TAVR may also be indicated in certain people who can't undergo open-heart surgery. The decision to treat aortic stenosis with TAVR is made after consultation with a multidisciplinary group of medical and surgical heart specialists who together determine the best treatment option for each individual. TAVR can relieve the signs and symptoms of aortic valve stenosis and may improve survival in people who can't undergo surgery or have a high risk of surgical complications.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace the aortic valve in people with aortic valve stenosis. Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body. Aortic stenosis can cause chest pain, fainting, fatigue, leg swelling and shortness of breath. It may also lead to heart failure and sudden cardiac death.
TAVR may be an option if you have aortic stenosis that causes signs and symptoms. For instance, people who are candidates for TAVR may include those who are considered at intermediate or high risk of complications from surgical aortic valve replacement. Conditions that may increase the risk of surgical aortic valve replacement include lung disease or kidney disease — which increase your risk of complications during surgical aortic valve replacement. TAVR may also be an option if you have an existing biological tissue valve that was previously inserted to replace the aortic valve, but it isn't functioning well anymore. Before TAVR, you'll need to be tested and evaluated by a multidisciplinary team of heart valve specialists. Doctors will evaluate your condition to determine the most appropriate treatment.
Transcatheter aortic valve replacement (TAVR) carries a risk of complications, which may include:
Transcatheter aortic valve replacement (TAVR) involves replacing your damaged aortic valve with one made from cow or pig heart tissue, also called a biological tissue valve. In some cases, a TAVR biological tissue valve may also be placed in an existing biological tissue valve that is no longer working in order to replace it.
You'll be evaluated to make sure you don't have any risk factors that may affect you during the TAVR procedure. You may be given a medication to reduce the risk of infection prior to your procedure.
You may receive general anesthesia before the TAVR procedure. A treatment team member will give you medication through an intravenous line to prevent blood clots. Your treatment team will monitor your heart function and rhythm, and watch for changes in heart function that may occur. Changes in function can be managed with treatments as needed during the procedure. During TAVR, doctors may access your heart through a blood vessel in your leg. Alternatively, your doctors may conduct the procedure through a tiny incision in your chest, and access your heart through a large artery or through the tip of the bottom left chamber of your heart (left ventricle). Doctors may sometimes use other approaches to access your heart.
In TAVR, a hollow tube (catheter) is inserted through the access point. Your doctor uses advanced imaging techniques to guide the catheter through your blood vessels, to your heart and into your aortic valve. Once it's precisely positioned, a balloon is expanded to press the replacement valve into place in the native aortic valve. Some valves can expand without the use of a balloon. When your doctor is certain the valve is securely in place, the catheter is withdrawn from your blood vessel or from the incision in your chest.
You may spend the night in the intensive care unit for monitoring after your procedure. Generally you'll spend about two to five days recovering in the hospital. You'll need to take blood-thinning medications to prevent blood clots after the procedure. Your doctor will discuss with you how long you may need to take these medications. Your doctor will recommend that you take medications before certain dental procedures to prevent certain infections, as you're at higher risk of certain infections with a replacement heart valve. Talk to your doctor about his or her recommendations.
Transcatheter aortic valve replacement (TAVR) can improve the lives of people with aortic stenosis who can't have surgery or for whom surgery is too risky. In these people, TAVR can reduce the risk of death. TAVR may also relieve the signs and symptoms of aortic valve stenosis and improve overall health. Some studies have found that TAVR has similar mortality rates as heart valve surgery in people with aortic stenosis who have an intermediate or high risk of complications from open-heart surgery. You may need to continue taking certain medications after your procedure. Take your medications as prescribed. You'll likely need regular follow-up appointments with your doctor.Transcatheter aortic valve replacement (TAVR) can improve the lives of people with aortic stenosis who can't have surgery or for whom surgery is too risky. In these people, TAVR can reduce the risk of death. TAVR may also relieve the signs and symptoms of aortic valve stenosis and improve overall health. Some studies have found that TAVR has similar mortality rates as heart valve surgery in people with aortic stenosis who have an intermediate or high risk of complications from open-heart surgery. You may need to continue taking certain medications after your procedure. Take your medications as prescribed. You'll likely need regular follow-up appointments with your doctor. Let your doctor know if you have any new or worsening signs or symptoms. Your doctor may recommend that you make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.
This pamphlet is for patients like you who have been evaluated by a team of heart doctors and selected for transcatheter mitral valve repair (or “TMVr”) with MitraClip™ therapy. MitraClip™ therapy is an approved treatment to repair your leaking mitral valve using an implanted Clip. Your team of heart doctors has determined that you would beneﬁt from having this procedure.
In the days before your procedure, it is important that you:
The following steps provide a general overview of the TMVr procedure with the MitraClip™ system—your experience may be diﬀerent. Your doctor will explain the procedure to you and can provide you with speciﬁc details and answer any questions you may have.
Your hospital stay following the procedure will likely range from one to ﬁve days, depending on your recovery and overall health. You should experience relief from your symptoms of mitral regurgitation soon after your procedure. Most patients will not need special assistance at home following discharge from the hospital, outside of ongoing needs for any unrelated health conditions.
While in the hospital, you will be closely monitored and your doctor will perform various tests to evaluate your heart function. You may be prescribed blood-thinning medications to help reduce the risk of developing a dangerous blood clot after the procedure. Your doctor or nurse will give you instructions about your medications before you leave the hospital.
You will be discharged to the care of your cardiologist or family doctor, who will ask you to return for follow-up visits. It is important that you keep all appointments for follow-up care and follow your doctor’s instructions
Potential adverse events that may occur during or after a procedure placing this device include, but are not limited to:
Following your procedure, you will receive an Implant Identiﬁcation Card, which your doctor will ﬁll out and which you must carry with you at all times.
Show your Implant Identiﬁcation Card if you report to an emergency room. This card identiﬁes you as a patient who has a MitraClip™ Implant. If you require a magnetic resonance imaging (MRI) scan, tell your doctor or MRI technician that you have a MitraClip™ Implant. Test results indicate that patients with the MitraClip™ Implant can safely undergo MRI scans under certain conditions described on the card.
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