Abstract

Background: Transcatheter aortic valve replacement has revolutionized the treatment of patients with severe aortic stenosis, who are considered intermediate to high risk for surgical aortic valve replacement. However, the adoption of this treatment modality has been remarkably low in Asian population as compared to the western world, especially in India. Aim: To describe the early experience of the TAVR program at our tertiary care hospital. Materials and methods: Retrospective review of patients who underwent TAVR at Amrita Institute of Medical Sciences, Kochi between 01/03/ 2016 to 30/04/2021. Results: There was a total of 19 patients who underwent TAVR (n=19), of which 5 (26 %) were females. 11 patients underwent TAVR with Medtronic self-expandable valves, and 8 patients with balloon expandable My Val Mean age of the patients was 75.93 +/- 9 years. (Mean SD). Mean STS score was 8.34 +/- 9.5. Mean Euro score is 8.3 +/- 11.5. Implantation was successful in 18 patients, in one patient the device got dislodged the next day. Permanent pacemaker was implanted pre-procedure in two patients and post-procedure in two patients. There was significant coronary artery disease in 9 patients, and amongst them three underwent concomitant PCI along withTAVR. 1 patient had a left ventricular (LV apical clot) and TAVR was done with cerebral protection. The mean follow up was 24 +/-6 months. 3 patients developed mild paravalvular leak, and 2 patients had mortality: one patient died 5 months post-procedure due to pulmonary oedema secondary to LV dysfunction and associated CAD, second developed pericardial effusion in hospital post operatively probably attributed to bleeding diathesis in the background of Polycythaemia Vera and CAD, and DIC. Five patients could not be followed up. Conclusion: TAVR procedure is feasible in severe aortic stenosis patients at intermediate to high operative risk for surgical AVR in the Indian context. With aging of the population, further reductions in cost, expanding indications and innovative technologies, TAVR adoption could certainly increase in India.

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