Transcatheter aortic valve replacement in India—Early experience, challenges, and outcomes from a single center

Abstract

BackgroundDespite the increasing popularity of transcatheter aortic valve replacement (TAVR), only about 10,000 TAVR cases have been performed in Asia to date. The procedure is still in a nascent stage in India with very few centers offering this state-of-art technique. Here, we present the early results of TAVR experience at our center.MethodsForty-nine patients with severe symptomatic aortic stenosis (AS) were referred to our center for TAVR from November 2015 to February 2018. Twenty-five patients underwent TAVR at our conventional cardiac catheterization laboratory under local or general anesthesia, with standby surgical team support.ResultsThe mean age of the patients was 72.0 ± 8.1 years. The mean Society of Thoracic Surgeons score was 13.8 ± 10.2. Baseline mean ejection fraction was 50.3 ± 14.8%. Baseline mean aortic valve gradient was 55.8 ± 24.7 mmHg. There was one procedural-related death. Two of the patients required urgent surgery: one for contained annular rupture and one underwent vascular repair for femoral artery occlusion. Mild and moderate paravalvular leak was seen in 11 and 3 patients, respectively. Four patients (16%) required permanent pacemaker. Eighty percent were in New York Heart Association class I-II at discharge. One-year all-cause mortality was 8%, with no hospitalizations or major adverse cardiac event during the 1-year follow-up.ConclusionOur early data clearly shows that in our country, TAVR is a good alternative for symptomatic severe AS for high surgical risk cases. Large-scale multicenter studies are required to study the real impact of TAVR in the Indian scenario. During initial years of implementation of a nationwide TAVR program, it may be prudent to focus on creating TAVR Centers of Excellence by developing an ideal hub and spokes model.

Early and late outcomes after transcatheter aortic valve implantation in Indian subpopulation

“…This was in contrast to 13.9% observed from US TAVI registry 2 and corresponding Indian study with all cause mortality of 8%. 3 Present study showed stroke rate of 13% which was quite high compared to other major studies as data from TVT registry report stroke rate of 2.5% at 30 days and 4.1% at 1 year and zero case from the Indian study. 3 , 4 …”

“… 3 Present study showed stroke rate of 13% which was quite high compared to other major studies as data from TVT registry report stroke rate of 2.5% at 30 days and 4.1% at 1 year and zero case from the Indian study. 3 , 4 …”

National interventional council data for the year 2018-India

“…There was increase in number of TAVR done during this year as the number of operators, the centers performing TAVR increased along with availability of made in India TAVR valve at a lower cost compared to pre-existing valves. 12 We are expecting further increase in number of TAVR procedures in coming years with expanding indications for TAVR and increased longevity in Indians. The NIC –CSI should try to capture the real time data which is robust with enormous research potential.…”