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Valve Clinic

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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 –

Improving patient outcomes by timely diagnosis and prompt, guideline based treatment of valve disease.
To have a multi-disciplinary “heart team” approach in dealing with complex valve diseases.
To spread community and patient awareness on valve diseases.

Highlights

India’s leading centre for Non-Surgical Valve Replacement & Repair.
Internationally trained Expert Doctors for Adult and Paediatric Structural & Valve Interventions, Cardiac Imaging, Cardiac Surgery.
Advanced 3D Echo Imaging, Hybrid Cath lab, State-of-the-Art ICU and more.

Services

Non-Surgical Valve Repair and Replacement – Transcatheter Aortic Valve Replacement / Implantation (TAVR / TAVI), MitraClip, Pulmonary valve (PPVI), Transcatheter Mitral Valve Replacement (TMVR), Balloon Mitral Valvotomy (BMV) etc
Minimal / Open Heart Valve Repairs and Replacement
Dedicated Cardiac Rehabilitation, Dietetics and Valve Clinic Nurse Coordinator

Transcatheter Aortic Valve Replacement (TAVR / TAVI) – Non-surgical valve replacement
Overview

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.

Why it's done?

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.

Who benefits most from TAVR

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.

Risks

Transcatheter aortic valve replacement (TAVR) carries a risk of complications, which may include:
What you can expect

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.

Before the procedure

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.

Transcatheter aortic valve replacement (TAVR) procedure approaches

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.

the procedure

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.

Results

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.

Prepairing For Your Transcatheter Mitral Valve Repair Procedure

ABOUT THE PROCEDURE TRANSCATHETER MITRAL VALVE REPAIR

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.

HOW SHOULD YOU PREPARE FOR YOUR PROCEDURE?

In the days before your procedure, it is important that you:

Take all your prescribed medications
Tell your doctor if you are taking any other medications
Make sure your doctor knows of any allergies you have
Follow all instructions given to you by your doctor or nurse

WHAT WILL HAPPEN DURING YOUR PROCEDURE?

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 doctor will make a small incision in your upper leg, where a Steerable Guide Catheter (a hollow, ﬂexible tube slightly larger than the diameter of a pencil) will be inserted through a vein to reach your heart.
The MitraClip™ Implant, which is attached to the end of a Clip Delivery System, will be guided to your mitral valve through the catheter. Your doctor will use imaging equipment to guide the placement of the Clip.
Your doctor will implant the Clip at the appropriate position on your mitral valve. The Clip will grasp the mitral valve leaﬂets to close the center of the mitral valve and reduce mitral regurgitation. Your doctor will then perform tests to conﬁrm that the Clip is working properly. In some cases, your doctor may implant a second Clip for further reduction of mitral regurgitation.
Once the Clip is in place and working properly, it will be disconnected from the Clip Delivery System. The Clip Delivery System and the Steerable Guide Catheter will then be removed from your body and the incision in your leg will be closed.
The implanted Clip will become a permanent part of your heart, allowing your mitral valve to close more tightly and reduce the backward ﬂow of blood.

WHAT WILL HAPPEN AFTER YOUR PROCEDURE?

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

AFTER BEING DISCHARGED FROM THE HOSPITAL, IT IS IMPORTANT THAT YOU:

Limit strenuous physical activity (such as jogging or activities that cause breath-holding, grunting, or straining such as lifting heavy objects) for at least 30 days, or longer if your doctor thinks it is necessary
Carefully follow your doctor’s instructions regarding medications you need to take, especially if blood-thinning drugs are prescribed
Call your doctor if you cannot keep taking your medications because of side eﬀects, such as rash, bleeding, or upset stomach
Notify your doctor before any medical or dental procedure; you may need to be prescribed antibiotics to avoid potential infection

WARNINGS

DO NOT use MitraClip™ outside of the labeled indication.
The MitraClip™ Implant should be implanted with sterile techniques using ﬂuoroscopy and echocardiography (e.g., transesophageal [TEE] and transthoracic [TTE]) in a facility with on-site cardiac surgery and immediate access to a cardiac operating room.
Read all instructions carefully. Failure to follow these instructions, warnings and precautions may lead to device damage, user injury or patient injury. Use universal precautions for biohazards and sharps while handling the MitraClip™ System to avoid user injury.
Use of the MitraClip™ should be restricted to those physicians trained to perform invasive endovascular and transseptal procedures and those trained in the proper use of the system.
The Clip Delivery System is provided sterile and designed for single use only. Cleaning, re-sterilization and / or reuse may result in infections, malfunction of the device or other serious injury or death.
Use caution when treating patients with hemodynamic instability requiring inotropic support or mechanical heart assistance due to the increased risk of mortality in this patient population. The safety and eﬀectiveness of MitraClip™ in these patients has not been evaluated.

PRECAUTIONS

Potential adverse events that may occur during or after a procedure placing this device include, but are not limited to:

Note the product “Use by” date speciﬁed on the package.
Inspect all product prior to use. Do not use if the package is open or damaged, or if product is damaged.
Prohibitive Risk Primary (or degenerative) Mitral Regurgitation
Prohibitive risk is determined by the clinical judgment of a heart team, including a cardiac surgeon experienced in mitral valve surgery and a cardiologist experienced in mitral valve disease, due to the presence of one or more of the following documented surgical risk factors:
30-day STS predicted operative mortality risk score of , ≥8% for patients deemed likely to undergo mitral valve replacement or ≥6% for patients deemed likely to undergo mitral valve repair
Porcelain aorta or extensively calciﬁed ascending aorta.
Frailty (assessed by in - person cardiac surgeon consultation)
Hostile chest
Severe liver disease / cirrhosis (MELD Score > 12)
Severe pulmonary hypertension (systolic pulmonary artery pressure > 2/3 systemic pressure)
Unusual extenuating circumstance, such as right ventricular dysfunction with severe tricuspid regurgitation, chemotherapy for malignancy, major bleeding diathesis, immobility, AIDS, severe dementia, high risk of aspiration, internal mammary artery (IMA) at high risk of injury, etc.
Evaluable data regarding safety or eﬀectiveness is not available for prohibitive risk DMR patients with an LVEF < 20% or an LVESD > 60 mm. MitraClip™ should be used only when criteria for clip suitability for DMR have been met.
The heart team should include a cardiac surgeon experienced in mitral valve surgery and a cardiologist experienced in mitral valve disease and may also include appropriate physicians to assess the adequacy of heart failure treatment and valvular anatomy.
Secondary Mitral Regurgitation
Evaluable data regarding safety or eﬀectiveness is not available for secondary MR patients with an LVEF < 20% or an LVESD > 70 mm.
The multidisciplinary heart team should be experienced in the evaluation and treatment of heart failure and mitral valve disease and determine that symptoms and MR severity persist despite maximally tolerated GDMT.

YOUR IMPLANT IDENTIFICATION CARD

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.

IMPORTANT

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.

To book appointment call : 022-35475814 (From 10 am to 5 pm)

Toll Free - 1800 890 1111

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