TAVI / TAVR Valve Replacement in Ahmedabad

The aortic valve opens to let blood leave the heart and reach the body. When it becomes stiff and narrow, the heart must work harder. This is called aortic stenosis.

Transcatheter aortic valve implantation (TAVI), also called transcatheter aortic valve replacement (TAVR), places a new valve inside the narrowed valve through a thin tube called a catheter. The usual route is through an artery in the groin, without opening the chest. Both names describe the same treatment.

• Your team: Dr. Kulin Sheth participates directly alongside dedicated TAVI specialists at Apollo CVHF Hospital, Bodakdev, Ahmedabad. Senior cardiovascular and thoracic surgeons help assess suitability and guide treatment decisions.
• Clinic care: Consultations and follow-up with Dr. Kulin take place at Sheth Heart Clinic, Bopal.

• Why it happens: Calcium commonly builds up on the valve with age. A valve formed differently from birth can narrow earlier.
• What you may notice: Breathlessness, reduced walking capacity, chest discomfort, dizziness or fainting. These symptoms can be mistaken for ageing.
• Why treatment matters: Severe narrowing can damage the heart and cause heart failure.
• What medicines can do: They help associated problems but cannot reopen a fixed, severely narrowed valve.
• When replacement is considered: Usually when narrowing is severe and causes symptoms or affects heart function. Selected patients benefit before obvious symptoms appear.
• When monitoring is appropriate: Mild or moderate narrowing usually needs follow-up rather than immediate replacement.

An echocardiogram (echo) is an ultrasound scan of the heart. Its findings are considered alongside symptoms and examination. The heart valve disease page explains narrowing and leakage in other valves too.

“Sir, yeh operation hai kya?”

TAVI is a catheter-based heart procedure rather than open-heart valve surgery.

• With the usual groin approach, the chest is not opened and a heart-lung machine is generally unnecessary.
• It remains a major procedure requiring hospital admission, anaesthesia, monitoring and a team prepared to manage complications.
• The replacement is a tissue valve, made from biological tissue supported by a frame. It opens and closes within the old valve, which is usually left in place.

TAVI mainly treats severe aortic stenosis. It does not suit every patient or treat every valve problem, including disease of the mitral or tricuspid valves.

The heart team discusses the following with you and your family:

• Valve and heart: Severity, symptoms, heart function, valve shape and calcium deposits.
• Access: Whether the arteries can safely accommodate the catheter.
• General health: Age, mobility, frailty, kidney and lung function, and recovery needs.
• Other treatment: Whether bypass surgery, another valve procedure or surgery on the aorta is also needed.
• Long-term plan: Expected benefit, valve durability, possible future procedures and your preferences.

Important exceptions:

• TAVI may suit selected patients with low surgical risk; it is not reserved only for those unable to have surgery.
• Older age or frailty does not automatically make TAVI appropriate. Supportive treatment may be preferable if other illnesses severely limit likely benefit.
• A valve with two leaflets instead of three, a mainly leaking aortic valve or a failing replacement tissue valve needs a separate suitability assessment.

Both can treat severe aortic stenosis. The choice depends on your heart, health and future treatment needs.

Other options include:

• Monitoring: When replacement is not yet indicated.
• Balloon treatment: Sometimes stretches the narrowed valve as a temporary bridge; usually less lasting than replacement.
• Supportive care: When replacement is unlikely to provide meaningful benefit.

• Echo: Assesses narrowing and heart function.
• Computed tomography (CT): Detailed X-ray images measure the valve opening, surrounding structures and access arteries to plan treatment.
• Blood tests: Check kidney function, blood count and other relevant factors.
• Coronary assessment: Coronary angiography or an appropriate CT assessment may identify artery blockages that affect the plan. Testing does not automatically mean a stent is needed.

Bring existing echo reports and recordings, scans, angiography images, discharge summaries and your medicine list. These are reviewed before deciding what needs repeating.

1. A catheter is guided, usually from the groin artery, to the narrowed valve.
2. A compressed tissue valve is delivered, positioned inside the old valve and expanded.
3. Imaging and pressure measurements check its position and function before the catheter is removed.

The Apollo CVHF team has experience with both:

• Balloon-expandable valves: Opened using a balloon.
• Self-expanding valves: Their frame expands as it is released.

Selection depends on anatomy and the treatment plan; neither design is best for everyone.

Anaesthesia and preparation:

• Some patients have local anaesthesia to numb the access area, plus sedation to help them relax. Others are asleep under general anaesthesia.
• Temporary pacing may support the heartbeat during treatment. This does not automatically mean a permanent pacemaker is needed.
• Follow your team's instructions about fasting and medicines. Do not stop blood thinners or change diabetes medicines on your own.
• General advice on preparing for procedures supplements your individual instructions.

What are the benefits and important risks?

Potential benefits in suitable patients:

• Easier breathing, better walking capacity and improved quality of life.
• Improved survival when severe narrowing warrants replacement.
• Often quicker recovery than open-heart surgery.

Other heart, lung or general health problems may limit improvement.

Important risks:

• Bleeding or injury to the access artery.
• Stroke or kidney injury.
• Leakage around the new valve.
• Electrical conduction problems requiring a pacemaker.
• Valve infection or death.
• Rare complications requiring emergency surgery.

Your team explains your individual risk compared with surgery and leaving the valve untreated.

Will I need a pacemaker after TAVI?

Some patients need one; it is not routine for everyone.

• The valve sits close to the heart's electrical pathways. Pressure from the new valve can slow or interrupt the heartbeat.
• An electrocardiogram (ECG) records electrical activity before treatment and helps assess risk. Anatomy, valve type and position also matter.
• Rhythm is monitored afterwards. Some changes settle; persistent or significant heart block may need a permanent pacemaker.
• Problems can occasionally appear after discharge, so additional rhythm monitoring may be advised.

• Before discharge: The team checks rhythm, valve and kidney function, and the groin access site. Many patients walk early; discharge depends on stability, mobility, healing and support at home.
• At home: Increase walking and daily activities gradually. Obtain individual advice about lifting, driving, travel and work.
• Rehabilitation: A supervised cardiac rehabilitation programme may help rebuild stamina and confidence.
• Follow-up: Attend symptom and medicine reviews and repeat echoes, even when feeling well.
• Dental care: Maintain good dental hygiene and tell your dentist about the valve. Antibiotics are recommended before certain dental procedures; your team will explain when.

Further practical advice is available under recovery and follow-up.

When to seek help:

• Emergency care: Severe new breathlessness, persistent chest pain, fainting, significant bleeding, or sudden facial drooping, arm weakness or difficulty speaking.
• Prompt assessment: New dizziness or a very slow pulse after discharge, or unexplained fever that could indicate infection.

TAVI does not itself require lifelong anticoagulation, unlike a mechanical valve. Long-term clot-prevention medicine may still be needed.

• Recent coronary stents can change the choice and duration of medicines.
• Your plan balances clotting and bleeding risks, with clear instructions before discharge.
• Do not stop or combine these medicines without advice.

A second opinion can help clarify:

• Whether replacement is needed now.
• Why TAVI or surgery is recommended for your anatomy and health.
• What symptoms are likely to improve, and the relevant risks.
• How today's choice affects future valve treatment.

Dr. Kulin personally reviews existing reports and images before deciding whether more assessment or wider heart-team review is needed.

Arrange a cardiology consultation at Sheth Heart Clinic, Bopal. Chest pain, fainting or severe breathlessness needs urgent assessment rather than waiting for a routine second opinion.