The aortic valve is one of the heart’s four vital valves. It ensures that blood flows in one direction, from the heart to the rest of the body through the aorta. Over time, this valve can become narrowed or stiffened due to calcium deposits, a condition known as Aortic Stenosis (AS).
When the valve does not open fully, the heart must work harder to pump blood through the restricted opening. Eventually, this can weaken the heart muscle and lead to various complications. “In my clinic, I have seen patients experiencing various symptoms as the disease progresses, from effort intolerance, exertional chest tightness, intermittent fainting episodes, to more serious fainting episodes and hospitalization due to heart failure and puts them at risk of sudden cardiac death”, said Dr. Shafeeq Mattummal, Chair & Director of Cardiology at Meitra Hospital, Kozhikode.
Aortic stenosis is common among older adults. Studies suggest that around 12% of people aged 75 or above may have some form of this condition. At this age, many patients are considered unsuitable for open-heart surgery due to frailty or other health factors. Without treatment, severe aortic stenosis can be fatal, nearly half of such patients may not survive beyond one or two years.
Common symptoms include chest pain, dizziness, fatigue, and breathlessness during activity.
For decades, the standard treatment for severe aortic stenosis has been surgical aortic valve replacement, performed under general anaesthesia using cardiopulmonary bypass. However, the emergence of Transcatheter Aortic Valve Replacement (TAVR), also known as Transcatheter Aortic Valve Implantation (TAVI), has transformed the treatment landscape.
TAVI offers a minimally invasive alternative to open-heart surgery. Instead of opening the chest, doctors replace the damaged aortic valve using a specialized collapsible tissue valve, via a catheter inserted through a blood vessel in the groin (transfemoral approach). The procedure can be done under mild sedation in most of the patients, and patients usually recover much faster.
“TAVR is one of the most important therapeutic innovations in cardiovascular medicine in the last two decades. It has completely changed outcomes for many elderly patients who were once considered at high-risk for surgery,” notes Dr. Shafeeq Mattummal, who has been a pioneer in non-surgical heart valve therapy in the country.
In a TAVI procedure, a catheter, a thin, flexible tube, is inserted into a blood vessel and guided carefully to the heart under image guidance. Once positioned, a balloon may be used to open the narrowed valve. The new artificial valve is then delivered through the catheter and deployed precisely in place, pushing the old, calcified valve leaflets aside.
The replacement valve immediately takes over the job of regulating blood flow, improving heart function almost instantly. Most patients spend a day in the intensive care unit for observation and typically recover within three to five days.
After the procedure, patients are advised to take simple blood-thinning medications like aspirin for a period to prevent clot formation.
TAVI is primarily recommended for elderly individuals with severe symptomatic aortic stenosis who are at high, intermediate, or low surgical risk. It is now the first option for those considered inoperable / high risk due to age, prior surgeries, or multiple coexisting illnesses.
Before proceeding, each case is discussed by a multidisciplinary Heart Team, which includes interventional cardiologists, cardiac surgeons, imaging specialists, and anaesthetists. At Meitra, this team includes Dr. Shafeeq Mattummal, Dr. Anil Saleem, Dr. Murali P Vettath, and Dr. Anil Jose, who bring over two decades each of experience in complex valve therapy.
Patients undergo a detailed assessment involving echocardiography, CT aortogram, and coronary angiogram to determine suitability and plan the procedure.
Ever since the first successful TAVR in France in 2002, the procedure has evolved remarkably with newer valve designs and improved outcomes. Today, TAVI is performed widely across leading cardiac centres globally.
In India, Meitra International Centre for Structural Heart Diseases has emerged as a key institution offering this advanced treatment and is one of the very few centers in India who have experience with all the available valve types in the country. With a success rate exceeding 99% from over 400 complex procedures, Meitra is among the most experienced TAVI centres in India. The hospital is equipped with a Hybrid Cath Lab with image fusion technology, specially designed for such complex transcatheter interventions and supported by a dedicated team of trained cardiac nurses and technicians.
While TAVI has become standard of care for aortic valve stenosis, research is progressing rapidly in percutaneous replacement of other heart valves, including the mitral, tricuspid, and pulmonary valves. The progress in this field reflects a broader shift toward less invasive, patient-centered cardiac care.
With technology, expertise, and experience converging, Kerala’s healthcare sector is now at par with the world in offering advanced cardiac treatments. The availability of TAVI and other valve therapies at Meitra Hospital mark an important step forward in expanding access to lifesaving, minimally invasive heart procedures for patients across India, and neighboring countries.
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