Transcatheter aortic valve replacement (TAVR) which was first introduced in 1960 has now become a rapidly evolving, gold standard treatment for patients with aortic stenosis who require valve replacement. Novel technological advancements have made this otherwise complicated therapy a first-line treatment for many patients who are at extreme risk for conventional cardiac surgery. It has been especially since the last 10 years, that this treatment (TAVR), also called transcutaneous aortic valve replacement, has emerged as an effective as well as a minimally invasive treatment for aortic valve disease for patients at high risk for surgical TAVR. Before we proceed to details of this treatment, it is pivotal to get familiar with the Aortic stenosis, which is a condition that is a result of the aortic valve of the heart getting narrowed over time. This valve, under normal conditions, is responsible for allowing blood flow to be pumped from the main chamber of your heart to the rest of the body organs. However, when this valve's opening is considerably narrowed, the pressure on the heart muscle increases. This in turn, likely leads to numerous symptoms of chest discomfort, shortness of breath, leg swelling, fatigue, lightheadedness, syncope (passing out spells), and even sudden death.
In adults, there are main conditions that drive the body towards Aortic Stenosis
• The most common cause of aortic stenosis is degenerative (age-related calcium deposits).
• Congenital disorders (bicuspid aortic valve) which is the progressive wear and tear of a bicuspid valve present since birth.
• Scarring of the aortic valve due to rheumatic fever as a child or young adult.
Aortic valve stenosis can range on the scale from mild to severe. Aortic valve stenosis signs and symptoms generally manifest as a result of severe narrowing down of the valve. More often, these symptoms are recorded as a result of strenuous physical activity.
Signs and symptoms of aortic valve stenosis may include:
• Abnormal heart sound (heart murmur) that can be heard through a stethoscope
• Chest pain (angina) or tightness within the chest
• Feeling faint/dizzy or fainting as a result of activity
• Shortness of breath, especially out of the activity
• Fatigue, especially during times of increased activity
• Heart palpitations and convulsions: sensations of a rapid, fluttering heartbeat
• Not eating enough (mainly in children with Aortic Stenosis)
• Not gaining enough weight (mainly in children with aortic valve stenosis
NOTE: Not everyone with aortic stenosis has noticeable symptoms. But if you do experience any of these symptoms, visit your doctor.
The TAVR valve that is switched with the narrowed valve in the patient's heart will open and close to regulate the flow of blood. This TAVR valve is made of bovine (cow) heart valve which is stitched inside of an expandable stainless steel scaffold or stent. During the course of TAVR valve implantation, the new valve is puckered down to approximately the diameter of a pencil and then placed on a catheter. A small slit/incision is made in the groin, following which the catheter is fed through the femoral artery to the heart, fairly similar to the angioplasty procedure. The new valve is positioned directly inside the diseased aortic valve in the heart chamber where the catheter balloon is inflated to secure the valve in place. Immediately after this procedure, the implanted valve begins to work and perform the functions just like a normal, healthy valve would.
For a normal case of Aortic Stenosis, TAVR cardiac procedure is performed under the influence of general anaesthesia, in a hybrid operating room. A well-defined team of a cardiothoracic surgeon, an interventional cardiologist and a clinic coordinator operate together, employing the fluoroscopy and echocardiography techniques in order to guide the new valve to the site of the patient's diseased heart valve.
• One must note that this procedure has a good success rate on a generic scale and therefore provides hope when all the other surgical options are rendered useless. The transcatheter valve offers some patients the potential of a longer and good quality life ahead.
• Another advantage that the TAVR procedure serves over the open-heart surgery is that TAVR is performed in much lesser time.
• In terms of the recovery period, the average recovery period of a TAVR patient is a matter of only a few days in comparison to the two or three month recovery period taken post an open-heart surgery.
• Transcatheter aortic valve replacement (TAVR) ICD 10: ICD-10-PCS (International Classification of Diseases, 10th revision, procedure coding system) was fabricated with the aim of improving the coding of procedures to incorporate more specificity, while also allowing sufficient space for expansion in order to include technological advances in methods of treatment. This increased detail and attention dedicated to coding procedures although, provides a more accurate portrayal of a patient encounter but still lags behind as a result of some challenges.
In ICD-10-PCS, TAVR procedures are coded to the root operation “Replacement”. Replacement procedures are performed to put in a device (made of either biological or synthetic material) that replaces some or all of body parts. For eg., joint replacements, graft.
The appropriate table used to build the ICD-10-PCS TAVR procedure codes is found in the Medical and Surgical Section (value 0), under the Heart and Great Vessels Body System (value 2), and Root Operation Replacement (value R). The Body Part value is F, Aortic Valve. The surgical approach used is the next code character value 3, Percutaneous (entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure). A Qualifier value of H clearly indicates of a transapical approach for the transcatheter aortic valve implantation.
Transcatheter aortic valve replacement (TAVR) may carry a good success rate and have certain prospects better than the open-heart surgery. However, due to the very minute and deep procedure, there a handful of complications attached to the surgery, which may include:
• Blood vessel complications
• Problems with the replacement valve (which can happen if the implanted valve slips out)
• Heart rhythm abnormalities (arrhythmias)
• Kidney disease
• Heart attack
India is undoubtedly one of the leading global medical tourism destinations offering high quality of heart valve repair surgeries at affordable costs. The TAVR cost in India ranges from INR 350,000 to INR 850,000
In most of the Indian hospitals, there is the facility of cardiac ICU's as well as good post-operative diagnosis, which ensures proper care after the surgery completion. Many people can also afford the surgeries for aortic stenosis, especially the ones did through the transcatheter process. Hence, for people with children having aortic stenosis or patients of any age group, it is highly recommended to first consult with Indian cardiologists to pick up the health care institutions in India for a satisfying experience and effective solutions for their aortic valve implantation.