Rare Transcatheter Mitral valve-in-valve implantation performed on 78 year old at Aster RV Hospital
Bangalore, 19 February 2021: A 78-year-old woman suffering from a faulty mitral valve in the heart recently underwent a Non-surgical Transcatheter Mitral valve-in-valve Replacement procedure (TMVR) at Aster RV Hospital, giving her a new lease of life. Previously, two such procedures have been conducted in Karnataka, making this only the third of its kind in the state. The incidence of heart valve disease increases significantly with age affecting the longevity as well as quality of life for the elderly patients. Transcatheter valve replacement procedures have come up on the medical horizon as a boon to some of these patients who are deemed unfit for open heart surgery.
In this instance, the patient Lalitha (name changed) had already undergone an open-heart surgery for a leaking mitral valve in 2013. A prosthetic tissue valve was implanted during that operation. Over the last few years unfortunately, the surgically implanted valve had degenerated and was leaking, leading to debilitating symptoms. By the time she consulted the doctors at Aster RV Hospital in January 2021, she had already developed symptoms of heart failure –characterised by severe shortness of breath, swelling of her feet and difficulty in carrying out her day-to-day activities. A detailed medical examination revealed that a second open-heart surgery to change this artificial valve would be of very high risk to the frail patient due to her age and the severity of her symptoms.
The Heart Team at the Aster RV hospital comprising of cardiologists, cardiac surgeons and cardiac anaesthetists decided that replacing the valve non-surgically through a Trans catheter Mitral Valve-in-valve procedure (TMVR) which is far less risky and relatively safer. In this procedure, a new prosthetic valve is placed within the earlier failed prosthetic valve non-surgically.
"We successfully carried out a Transcatheter Mitral Valve-in-valve (V-in-v) implantation of Edwards Sapien 3 valve through a small incision in the vein in the patient's thigh. The procedure was done under short general anaesthesia and the patient came out of anaesthesia in the Cath lab just after the procedure. She recovered quickly, walked home after 4 days and has recovered fully now. Trans-catheter valve procedures are available in India only in recent years and can be beneficial, particularly for older patients as it is possible to perform otherwise high risk procedures without resorting to open-heart surgery and the results are very good," said Dr. S. Venkatesh, Lead Consultant, Interventional Cardiology, Aster RV Hospital. "Therefore, these can be of great value in treating elderly, high-risk patients as well as those who have undergone prior heart operations," he added. While transcatheter procedures are far more common for the aortic valve, they can also be useful for mitral valves and like in this case, previously implanted degenerated heart valves.
Incidentally, the first transcatheter Aortic valve-in-valve procedure in Karnataka state was also performed by the cardiac team at Aster RV hospital.