Hyderabad, January 11th, 2018: A pioneering cardiac procedure, percutaneous Transcatheter Aortic Valve Replacement (TAVR) was performed on an eighty-two-year-old man with critical calcific Aortic Stenosis at Citizens Specialty Hospital, Hyderabad. The team of specialists was led by Dr. A Sreenivas Kumar, Consultant Cardiologist and Chief of Cardiac Services, Dr Gokul Reddy, Consultant Cardiologist and Director of Cath labs and assisted by Dr V Hariram, Sr. Consultant Cardiologist, Dr E Sanjeev Kumar, Sr. Consultant Cardiologist, Dr Sudheer Koganti, Consultant Cardiologist and Dr J Ramakrishna, Consultant Cardiologist. Dr. Vikram Aerra, Sr. Consultant CT Surgeon, provided surgical back up.
Dr Venugopal and Dr Viswanathan looked after anesthetic aspects. Dr Ravi Bathina helped with non-invasive imaging and in getting all valve measurements on CT scan. Till date, only handful of procedures have been performed in the city of Hyderabad and combined Telugu states.
Narrowing of the aortic valve, one of the four valves of the heart is called Aortic stenosis. Aortic stenosis is a mechanical problem in which the leaflets of the valve are fused to such an extent whereby there is a mechanical obstruction to blood flow as it is ejected by left ventricle, the main pumping chamber of the heart. This leads to exertional breathlessness, chest pain, dizziness and heart failure in some. Left alone patients develop symptoms due to severe heart failure or abnormal heart rhythm and succumb to it.
Conventionally aortic valve is replaced with either a tissue or bioprosthetic valve by open-heart surgery. Increasingly TAVR is also becoming an alternative particularly in those that are considered at moderate to high risk for open-heart surgery. Our patient was deemed to have at least moderate risk due to his advanced age and chronic kidney disease and therefore was considered for the minimally invasive TAVR.
TAVR for this patient was performed in the cathlab from the groin region (right femoral artery) just like in angioplasty. Once the patient was anaesthetised, Evolute – R percutaneous arotic valve (made by Medtronic USA) was advanced to the heart through the femoral artery, positioned accurately under the guidance of fluoroscopy and then implanted. The whole procedure was completed in 90 minutes. Immediately after the procedure the patient was extubated and shifted to surgical ICU. Following adequate recovery, he was discharged home 3 days later.
TAVR is routinely performed in high numbers in the western world for patients who are at moderate to high risk for Open Heart Surgery. Slowly but steadily the number of TAVR procedures performed are increasing in India. However, cost of the valve remains prohibitive and with Indian valves on the horizon this may come down too. TAVR is now a life-saving procedure for patients with aortic stenosis who are not fit for open heart surgery and we can offer this now at Citizens hospital.
Dedicated Heart Failure Clinic at Citizens Specialty Hospital
Citizens Specialty Hospitals, Hyderabad, also announced the launch of Heart Failure Clinic. The Citizens Heart team led by Dr. A Sreenivas Kumar, Consultant Cardiologist and Chief of Cardiac Services, Dr Gokul Reddy, Consultant Cardiologist and Director, and Dr Sudheer Koganti, Consultant Cardiologist, disclosed the functioning of a dedicated Heart Failure Clinic at the hospital, at the Press Conference organised on the 11th January, 2018.
Dr Sudheer Koganti, Consultant Cardiologist, trained in the UK at reputed institutes such as The Royal Free Hospital London, St Bartholomew’s Hospital, London – Europe’s largest cardiothoracic centre, University College London Hospital with expertise in acute heart failure in using devices such as Impella, revascularisation in heart failure and also stem cell therapy configured the services.
Heart Failure (HF) is a condition in which weakened heart muscle results in reduced pumping function. This leads to reduced blood and oxygen supply to vital organs including heart itself. Heart Failure is a chronic and progressive condition usually caused by coronary artery disease, valvular heart disease, heart muscle disease and due to uncontrolled blood pressure.
Heart failure is a grave condition with a poor prognosis. It is also a condition where the incidence and prevalence are increasing worldwide. In the western world the increasing prevalence is partly due to ageing population whereas in India younger cohort are affected due to rampant coronary artery disease, diabetes and high blood pressure. The mortality and morbidity associated with severe heart failure is often worse than that of various cancers.
Speaking on the occasion, Nilesh Gupta, Zonal Director, American Oncology Institute and Citizens Specialty Hospital said, “Incidence of heart failure in India is over 50 lacs, with 10 lac patients adding on every year to this number. For some reason, heart failure carries a high mortality in India with as much as 2.5 lacs in the first year after diagnosis. One of the reasons may be due to over representation of traditional risk factors such as diabetes, high blood pressure and also probably due to poor compliance with medications.
Heart failure patients are at risk of sudden death from fatal arrhythmias and often carry poor prognosis. The poor prognosis is often not appreciated by the patient and hence the need for a dedicated heart failure service.”
Dr. A Sreenivas Kumar, Consultant Cardiologist and Chief of Cardiac Services, Citizens Specialty Hospital said, “Advances in medical and interventional management aid in effectively managing heart failure and ensure good quality of life. Inception of the hospital-based Heart Failure Clinic at Citizens Specialty Hospital has the potential to offer a well-directed, patient orientated multidisciplinary care.”
Dr Sudheer Koganti, Consultant Cardiologist, Citizens Specialty Hospital said, “Dedicated heart failure service helps in effectively screening patients at risk. The model of heart failure clinic at Citizens is via a bi-monthly, one-stop diagnostic clinic. Subsequent care of those diagnosed with heart failure in this clinic is continued through hospital-based, doctor led up-titration clinics with future plans to initiate home visits.”
Furthermore, once diagnosed, heart failure clinic aids in up titrating drugs and also escalate management to complex device management and transplantation. Complex cases will be discussed in multidisciplinary team to see if one would benefit from revascularisation, biventricular pacemaker implantation, LVAD implantation and even transplantation. Acute heart failure following heart attack may need support with inta aortic balloon pump (IABP), Impella heart pump or extra corporeal membrane oxygenation (ECMO). All these services will be provided at Citizens Heart Failure Clinic.
About Citizens Specialty Hospital
Citizens Specialty Hospital aims to close the gap between standards of health care in India/South Asia & the developed world. The hospital provides specialty healthcare based on world-class standards of care and evidence-based protocols across a broad range of medical specialties for inpatients and outpatients. Spread across 10.5 acres campus in Nallagandla, near the University of Hyderabad, 300 bedded Citizens Specialty Hospital offers round-the-clock healthcare based on the latest clinically-proven medical protocols and evidence based treatment planning processes to deliver superior outcomes for patients.
