Symptoms of Severe Aortic Stenosis

Aortic stenosis can progress gradually, and symptoms may initially be mistaken for normal ageing or reduced fitness.

Common symptoms include:

• Breathlessness during activity
• Chest pain or pressure
• Dizziness
• Fainting or near-fainting
• Reduced exercise tolerance
• Unusual tiredness
• Difficulty performing routine activities
• Palpitations in some patients
• Swelling of the legs in advanced heart disease

Symptoms should be evaluated by a cardiologist, particularly when they are new, worsening or occur with exertion.

Sudden severe chest pain, severe breathlessness, fainting or collapse requires urgent medical evaluation.

What Causes Aortic Stenosis?

Aortic stenosis can develop for several reasons.

Age-Related Valve Calcification

Calcium can gradually accumulate on the aortic valve, making the valve stiff and reducing its ability to open.

Congenital Bicuspid Aortic Valve

Some people are born with a bicuspid aortic valve rather than the usual three-leaflet valve. This can increase the risk of valve disease.

Rheumatic Valve Disease

Previous rheumatic fever can damage heart valves and may contribute to aortic valve disease.

Other Valve Disorders

Other structural abnormalities can also contribute to narrowing of the aortic valve.

Tests Before TAVI

Before TAVI treatment in India, the heart-valve team performs a detailed evaluation.

Echocardiogram

Echocardiography is one of the key tests used to assess the aortic valve and determine the severity of aortic stenosis.

ECG

An electrocardiogram records the heart’s electrical activity and may identify associated cardiac abnormalities.

CT Scan for TAVI Planning

CT imaging can help assess the aortic valve, aortic root, surrounding structures and blood vessels used to access the heart.

Coronary Angiography

Coronary angiography may be performed to assess coronary artery disease when clinically appropriate.

Blood Tests

Blood tests may be used to evaluate kidney function, blood count and other factors relevant to the procedure.

Heart-Team Assessment

The results are considered together with the patient’s symptoms, age, overall health, anatomy and procedural risk.

How is TAVI Performed?

Transcatheter Aortic Valve Implantation in India is performed in a specialized cardiac catheterization or hybrid procedure environment.

The general process includes:

1. Pre-Procedure Planning

Detailed imaging and clinical evaluation are used to select the appropriate valve and access route.

2. Vascular Access

A catheter is generally introduced through a blood vessel, commonly through the femoral artery in the groin when transfemoral access is suitable.

3. Catheter Guidance

The catheter is carefully guided toward the diseased aortic valve.

4. Valve Positioning

The replacement valve is positioned within the existing diseased valve.

5. Valve Deployment

The transcatheter valve is expanded or deployed, depending on the valve system being used.

6. Final Assessment

Imaging and hemodynamic assessment are used to evaluate valve function and check for complications.

The exact technique depends on the patient’s anatomy, valve type and selected access route.

How is the TAVI Valve Delivered?

The transfemoral approach is commonly used when the patient’s blood vessels are suitable.

For patients who are not appropriate candidates for transfemoral access, alternative access strategies may be considered depending on anatomy and institutional expertise.

The access route is determined during detailed pre-procedure imaging and planning.

TAVI vs Surgical Aortic Valve Replacement

TAVI or Open-Heart Valve Replacement?

Patients often ask whether TAVI is better than surgical aortic valve replacement.

There is no single approach that is suitable for every patient.

TAVI

TAVI is a catheter-based valve replacement procedure that avoids conventional open-heart surgery.

Surgical Aortic Valve Replacement

SAVR involves surgically replacing the diseased aortic valve.

How is the Decision Made?

The decision may consider:

• Age
• Symptoms
• Aortic stenosis severity
• Life expectancy
• Surgical risk
• Valve anatomy
• Vascular anatomy
• Presence of other cardiac conditions
• Previous cardiac surgery
• Suitability for a transcatheter valve
• Long-term considerations

Current valve guidelines emphasize individualized and shared decision-making when choosing between transcatheter and surgical valve replacement.

TAVI Benefits

Potential Benefits of TAVI

For appropriately selected patients, TAVI can offer several potential benefits compared with conventional surgical valve replacement.

Minimally Invasive Approach

TAVI is performed through catheter-based access rather than conventional open-heart surgery.

No Traditional Chest Opening

Transfemoral TAVI does not generally require a traditional sternotomy.

Shorter Recovery for Many Patients

Recovery can be faster for some patients compared with surgical valve replacement, although individual recovery varies.

Improved Symptoms

Successful valve replacement can improve symptoms caused by severe aortic stenosis.

Return to Daily Activities

Many appropriately selected patients can gradually return to normal activities after recovery.

What Are the Possible Risks of TAVI?

Although TAVI is a well-established treatment, it is still a significant cardiac procedure and can have complications.

Potential complications include:

• Bleeding
• Blood vessel injury
• Stroke
• Infection
• Abnormal heart rhythm
• Need for permanent pacemaker
• Leakage around the replacement valve
• Kidney injury
• Valve-related complications
• Need for additional intervention
• Rarely, death

The risk depends on the patient’s age, health, anatomy, valve type, access route and other medical conditions.

Your heart-valve team should explain the individual risks and expected benefits before the procedure.

Recovery After TAVI

Recovery varies between patients.

After TAVI, the medical team monitors:

• Heart rhythm
• Blood pressure
• Valve function
• Access site
• Kidney function
• Signs of bleeding or other complications

Patients are given specific instructions regarding medicines, physical activity, wound care and follow-up.

After TAVI, patients may be advised to:

• Take prescribed medicines regularly
• Keep the access site clean
• Avoid strenuous activity until medically cleared
• Attend scheduled echocardiography and cardiology follow-ups
• Monitor for new or worsening symptoms
• Follow recommended heart-health measures

Life After TAVI

TAVI replaces the diseased aortic valve, but continued cardiac care remains important.

Life After TAVIular follow-up may include:

• Clinical examination
• Echocardiography
• ECG
• Monitoring of blood pressure
• Assessment of symptoms
• Assessment of valve function
• Management of coronary artery disease and other cardiovascular risk factors

Your cardiologist will determine the appropriate follow-up schedule based on your condition and valve type.

Is TAVI Suitable for Older Patients?

TAVI was initially used predominantly in patients at increased surgical risk, but its use has expanded to selected patients across different risk categories.

However, age alone does not determine whether TAVI is appropriate.

The decision should consider overall health, life expectancy, valve anatomy, vascular anatomy, surgical risk and patient preferences.

TAVI for Patients at High Surgical Risk

For selected symptomatic patients with severe aortic stenosis who have high or prohibitive surgical risk, TAVI can be an important treatment option when the expected survival and quality of life after treatment are acceptable.

A detailed heart-team assessment is essential before making the decision.