Say goodbye to heart surgery
Dr Ashok Seth

Treatment of heart disease has evolved a great deal in the past decade. Dreams of the past are becoming a reality today. Whether it's a damaged heart valve or a blocked artery, you can expect the safest option involving least trauma and best results. Some of these include:

Transcatheter Aortic Valve Replacement (TAVR):This is a technique to replace one of the valves of the heart without 'open heart surgery'. The heart is a muscular pump which supplies oxygenated blood to all parts of the body including the liver, kidneys, brain. The 'aortic valve' allows blood to flow only in one (forward) direction. Due to a defect of this valve from birth or because of ageing, this valve may develop calcium deposits that narrows it and restricts it from opening fully. This stops the blood from passing through to the brain and the rest of the body-a condition known as 'aortic stenosis'.

Aortic stenosis affects nearly 4 to 5% of the elderly population and once severe, leads to death in most cases within two years. Until recently, the only way to replace this valve with a new one was through a major surgery which involved stopping the heart, putting the patient on a 'bypass pump' and cutting open the heart to put in a new valve. Now, in one of the biggest breakthroughs in medical science, this can be done non-surgically through a puncture in the groin, in the cath lab in an angioplastylike procedure. The procedure lasts for approximately two hours. Also, because it's non-surgical, it is safer and the patient can be discharged in three to four days.

It's particularly recommended for seniors whose age makes surgery a risky affair. Recently we used this technique for the first time in India to successfully treat three patients (aged 71, 72 and 80). These patients had severe aortic stenosis and had been refused surgery because of high risk factors. All three recovered rapidly and are now leading a fully active and normal life.
[IMG]file:///C:%5CUsers%5CViji%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_image002.jpg[/IMG]Bioabsorbable Stents: When arteries of the heart get blocked by cholesterol deposits, heart attacks can occur. One of the most widely used and successful treatments of coronary artery disease involves angioplasty where small stainless steel spring-like devices coated with a drug called 'Drug Eluting Stents' are inserted into the arteries to remove the blockage and keep the arteries open. But, having a piece of metal in the heart arteries throughout your life has some disadvantages including the fact that the patients have to be on blood thinning tablets throughout their life.

There are now 'stents' which are made of a certain plastic-like material, which, after doing their job of opening up the heart arteries and gradually dissolve and disappear in about two years leaving the artery totally normal. This fascinating and revolutionary treatment was first used in India at Fortis Escorts Heart Institute in October, 2010 as a part of a study. The bioabsorbable stents are expected to be in regular use from next year and may do away with the need to take long-term blood thinners.

Renal Denervation (RDN): This is another new treatment around the corner. Meant for patients with abnormally high BP, this is a brief non-operative angioplastylike procedure, wherein the nerves to the kidney are interrupted by a microwave catheter. The patient is fine to walk and be discharged the next day. The procedure is expected to be a onetime cure for high blood pressure decreasing the lifelong need for multiple BP medications.

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