The thought of undergoing open-heart surgery for heart valve replacement can be daunting, even for a very fit patient. There is no doubt, for the elderly patients or those who already had previous operations, or those with previous strokes, lung disease, kidney disease, general frailty, open-heart surgery comes with a lot of risks, during and after the surgery.
Every year, many such patients who need an aortic valve replacement, are deemed to be of high risk, will be turned down for open-heart aortic valve replacement surgery and eventually end up with prolonged heart failure or sudden death.
Due to innovation and progress in the medical industry and skilled medical specialists over the last few years, this unmet need for high-risk valve replacement has become simpler and safer with the use of TAVI (Transcatheter Aortic Valve Implantation).
Under the guidance of Dr Pandula Athaudarachchi, who has trained for many years as a Consultant in the United Kingdom and many other European centres offering these sophisticated procedures, Durdans Heart Centre has reached a landmark of completing 5 such completely successful TAVI cases for the first time in the country, whilst the patient is awake and under local anaesthesia only.
Dr Pandula Athauda-Arachchi thus becomes the first Sri Lankan fully independent specialist to have implanted TAVI valves successfully this way. He also has the credit of implanting devices in two different platforms and performing Sri Lanka’s first TAVI for morphologically abnormal bicuspid valves as well as the normal tricuspid valves with the disease.
The aortic valve plays a key role in the body’s blood pumping mechanism, failure of which causes chaos in all of the vital organs. Factors such as age-related wear and tear or defects from birth can cause the aortic valve to narrow, restricting blood flow which deprives the rest of the body of oxygen. Dr Pandula Athuada-Arachchi explained that the Transcatheter Aortic Valve Implantation (TAVI), with meticulous pre-planning, enabled him to replace the valve within 90 minutes in certain cases. Despite operating on high-risk individuals, it reduces the risks associated with open-heart surgery and general anaesthesia. It involves carefully choosing and placement of a balloon-expandable (MyVal or Edwards) or self-expanding (Medtronic Evolut™ R) transcatheter aortic heart valve after precise crushing off of the diseased valve leaflets.
The procedure is performed by inserting a catheter with the valve into the body through a small incision and navigating it to the affected valve, the patient remains fully conscious during the procedure, which only lasts about 90 minutes. TAVI allows for a shorter recovery time, mobilisation within 24 hrs and reduces the risk of infection, stroke, need for dependence on ventilators. Typically, despite their age or multiple medical issues, patients can be discharged from the hospital in 3 days.
Recently, TAVI was performed on two elderly patients at the Durdans Heart Centre who were extremely satisfied with their experiences.
“We are extremely happy about the procedure. I recovered quicker than I expected and Dr Pandula treated me very kindly. The doctor and I discussed concerns before the surgery and he explained everything to me. I am 75 years old now and have consulted many doctors but no one has attended to our needs in this way before. He briefed me well on the surgery and it went very smoothly. I came out of the surgery feeling good and talking like normal. The ICU and the CATHLAB services were also superb,” said a patient.
“In 2020 my father did a routine check-up and it was found that the aortic valve was calcified and in bad condition. The doctor said that he would have about a year to live and suggested the TAVI procedure. My father is 85 years old and did not want to go through any surgery but eventually ended up doing so. My father didn’t feel anything at all during the surgery. He wanted to go to Galle Face Green just four days after the surgery! It’s like he has been given a new lease on life. He is so active and has so much energy. His overall health is improving. Everyone should know about this procedure that Dr Pandula is performing. This is a superb option for anyone who cannot undergo open-heart surgery,” said the patient party.