CHENNAI: In a rare medical procedure, a septuagenarian woman underwent Transcatheter Aortic Valve Replacement (TAVR) in a city hospital in a fully awake condition and entire procedure was completed in incredible 90 minutes, arguably the best in the country.
75-year-old Nirmala Ramanlal with severe aortic stenosis has consulted Dr. KM Cherian Heart Foundation, Frontier Lifeline Hospital for heart valve replacement after being rejected by several other leading healthcare institutes due to risk factors. Nirmala with multi medical problems including cancer of her bowel for which she had surgery in 2011 was undesirable for open heart surgery.
After lot of discussion, the team at Frontier Lifeline decided to go for TAVR with new imported CoreValve called Evolut R developed recently by Medtronic in Netherlands.
Senior consultant cardiologist Dr Rajaram Anantharaman, who performed the procedure, told Express that usually such procedures are performed under general anesthesia (putting the patients to sleep on a ventilator). “However, in this case we were able to do it with local anesthesia. The regular TAVR is 18 fr, but what we used was 14 fr which made it possible to keep the patient awake.”
Another important improvisation the team tried was that after completion of the procedure, the large tube in the groin artery was removed and closed with non-surgical percutaneous suture, which meant not a single stitch was needed.
When Express visited the hospital, Nirmala was sitting and chatting with her husband. Her husband Ramanlal D Vikam said she underwent TAVR on the eve of her birthday. She turned 75 on Thursday and looking all healthy. Within 24 hours, Nirmala was able to walk and doctors said she would be discharged on Saturday.
Since Transcatheter Aortic Valves are not available in India, they have to be imported and with stringent laws on imports, the patients are made to wait for months. Nirmala has waited for nearly two months for the valve and the cost of the Evolut R Valve was `20 lakh.Dr KM Cherian, founder of Frontier Lifeline Hospital, said not many patients could afford it. “We plan to manufacture TAVR valves in our Mediville SEZ. We will be shortly taking up the phase-III trials of biological and bioprosthetic valves. However, we need some support from the government and regulatory agencies, which unfortunately is lacking.”