• One-of-a-kind procedure performed in Bengaluru
• First case in Bengaluru, second in Karnataka and fourth in the country
• Implant done successfully on a senior citizen with underlying health conditions, making the case challenging and first for the cardiologists.

25 July 2023, Bengaluru: Team of Cardiac sciences at Aster RV Hospital recently performed an extremely rare heart valve procedure. This was the first in case for Bengaluru & fourth in India. An artificial valve was implanted in the heart of an elderly gentleman through the carotid artery- an artery that exists in the neck region which is responsible for supplying blood to the brain.

The blood pumped by the heart has to traverse through the aortic valve, to be supplied to the whole body. Narrowing of one of these four valves of the heart results in Aortic stenosis- a universally found heart problem.  It has been commonly observed across the elderly, where the valve degenerates with age, becomes stiff, and hard due to deposition of calcium. Constriction of the size of the valve makes the flow of blood through the valve difficult. This makes the heart work harder and can cause symptoms like fatigue, shortness of breath, and chest pain. Untreated severe aortic stenosis can also be life-threatening. In such cases, Transcatheter valve replacement (TAVR) is undertaken and has been performed across the globe for the past decade. This is conventionally performed through the main arteries of the legs. However, in this case, the patient had hardened and blocked leg arteries, which made the surgeons opt for another route for implantation by uniquely undertaking the same through his neck vessels. 

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“Typically, the treatment of Severe Aortic stenosis is by replacement of the patient’s valve with an artificial or Prosthetic valve, performed often by open heart surgery – Surgical Aortic Valve Replacement (SAVR). In the last few years, the replacement can also be done without heart surgery by a procedure called Transcatheter Aortic Valve Replacement (TAVR or TAVI, in short). This entails the delivery of a prosthetic valve to the heart via the artery in the groin or thigh (somewhat similar to a stent procedure for blockages in the arteries of the heart. This is a preferred over SAVR in patients who are deemed to be unfit for open heart surgery,” said Dr S Venkatesh, Lead Consultant – Interventional Cardiology, Aster RV Hospital. 

Commenting on the surgery, Dr Divakar Bhat, Consultant – CTVS Surgery, Aster RV Hospital said, “The patient is a 73-year-old gentleman who had undergone a bypass surgery in the past & his heart pumping capacity is reduced. He is undergoing regular dialysis for renal failure. He was recently admitted with severe breathlessness and was discovered to have severe aortic stenosis. Upon discussion with the cardiac surgeon and cardiac anaesthetist, the surgical risk of complications for SAVR was determined to be was very high and hence he was advised TAVR procedure. During evaluation for the same, both leg arteries were found to be heavily calcified. Hence, we decided to probe the novel option of using the arteries in the neck. Using state of the art monitoring of brain oxygenation using Near Infra-Red Spectroscopy system, throughout the procedure, we were successfully able to implant a new valve.”

The procedure required expertise and vital coordination between the Cardiology, Cardiac Surgery & Anaesthesia teams. The patient has recovered well and has been discharged in stable condition. He has now resumed all his activities and is leading an active life.

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