Aortic Stenosis Treatment

Who Needs Aortic Stenosis Treatment?

There are different segments of people diagnosed with aortic stenosis requiring this treatment. 

Symptomatic Patients with Severe Aortic Stenosis

An individual with the following symptoms requires treatment immediately to prevent heart failure or sudden cardiac death:

• Pain in the chest 
• Shortness of breath 
• Light-headedness
• Fatigue 
• Palpitations in the heart

Asymptomatic Patients with Severe Aortic Stenosis

This disease can also occur in humans without showing any relevant symptoms, and in this scenario, treatment is recommended. Asymptomatic patients are diagnosed with the following:

• Weakening of the left ventricle 
• The ejection fraction is falling, which means the heart's pumping function 
• Evidence of highly severe valve shrinking or high-pressure gradient across the valve

Types of Aortic Stenosis Treatment

Aortic stenosis treatment is dependent on the severity of the condition, the presence of symptoms, and the whole status of health status of the patient. 

Aortic Valve Replacement (Primary Treatment)

Surgical Aortic Valve Treatment (SAVR)

This treatment involves removing a damaged aortic valve and replacing it with a prosthetic valve. It is a well-developed conventional method used when the valve is narrowed and blood flow from the heart is restricted. This treatment is also applicable when the valve is facing leakage issues and blood flows backward into the heart. It is recommended for patients with severe symptoms of aortic stenosis. 

Transcatheter Aortic Valve Replacement (TAVR)

It is a minimally invasive process conducted through a catheter inserted through the groin. It is preferable for older patients suffering from high or immediate surgical risk or some low-risk patients as well, because these are increasing at a higher rate. It has a faster recovery in comparison to SAVR. 

Balloon Valvuloplasty

In this treatment, there is proper inflation and insertion of a Balloon Catheter to broaden the shrinked valve. It is often optimised as a temporary method or used in specific scenarios, like among children and young adults who are suffering from congenital aortic stenosis. It is also applied to critically ill patients as a medium for the replacement of valves. Adult patients with degenerative AS do not qualify. 

Medical Management 

It is a non-surgical process where medicines are used. No medications can cure aortic stenosis; they can manage the symptoms or extreme complications like failure of the heart, arrhythmias, and hypertension. It is also used for those patients who are not comfortable continuing with surgery or TAVR. With these medications, close supervision is mandatory.

Evaluation and Diagnostics Before Aortic Stenosis Treatment

Before making any decisions on aortic stenosis treatment, a thorough diagnosis is required. This helps for the determination of the seriousness of the disease, the existence of symptoms, and the functionality of the heart, along with the best treatment option available for managing aortic stenosis. For clinical assessment, a review of the symptoms, medical history, and functional status is important. 

Pre-procedure planning 

• For TAVR, the access route is important, along with valve sizing based on the measurements of the CT scan. 
• Further, the anesthesia method is also regulated along with an anticoagulation and antibiotic prophylaxis plan.
• For SAVR, the surgical approach is also considered along with choosing the valve, planning for cardiopulmonary bypass, and general anesthesia preparation. 

Evaluation Before Aortic Stenosis Treatment

Assessment of the surgical risk is done by optimizing thoracic condition, surgeon score, EuroSCORE II, cognitive status, frailty, and life expectancy.

Medical History and Physical Examination 

The following classical symptoms need to be assessed:

• Pain in the chest 
• Shortness of breath 
• Dizziness 
• Murmuring of the heart 

Diagnosis Tests

• Echocardiogram 
• Transthoracic echocardiography
• Electrocardiogram 
• CT scan or MRI 

Procedure Planning

It can be a surgical aortic valve replacement or a transcatheter aortic valve replacement that requires a systematic multidisciplinary approach to secure the most efficient outcome.

Multidisciplinary heart team involvement

A highly qualified and dedicated heart specialist team includes: 

• Cardiologist 
• Cardiothoracic surgeon 
• Interventional cardiologist 
• Cardiac anaesthesiologist 
• Imaging specialist 
• Geriatrician for older patients

This team will work coherently and collaboratively in order to confirm the diagnosis and the seriousness of the disease. They will also assess procedural risks and determine the most significant treatment option. 

Risks and Potential Complications of Aortic Stenosis Treatment

Risks and complications included in aortic valve replacements

• Bleeding during or after the surgery 
• Infection at the incision site or in the chest 
• Occurrence of stroke 
• Problems in heart rhythm 
• Dysfunctional attributes of the kidney 
• Complications in vascular activities 
• Leakage in the paravalvular area  

Risks and complications included in the medical management

People who are not undergoing surgeries can also have risks and limitations in medical management. This includes high proximity of heart failure, sudden cardiac death, poor life quality, and limited prolonged survival. 

Recovery After Aortic Stenosis Treatment and Long-Term Care

Recovery After SAVR

• After the open-heart surgery minimum of 5 to 10 days of observation within the hospital is required based on the complications. 
• It requires around 6 to 12 weeks for primary recovery. 
• Common symptoms noticed in the post-recovery phase are mild discomfort within the chest, fatigue, mood swings, and disturbance in sleep. 
• Patients who went through immediate surgery need not lift heavy objects for 2 months, and also not drive for 4 to 6 weeks. 

Recovery After TAVR 

Minimum 1 to 5 days in hospital, 1 to 4 weeks initial recovery, it recovers much faster than SAVR, especially among older patients and high respiration. 

Long-Term Care After Aortic Stenosis Treatment

Lifelong follow-up and regular doctor visits are mandatory to check the symptoms of valve dysfunction, along with the possibility of heart failure. Proper medications are required after surgery, including those with anticoagulant properties, and also for people managing blood pressure. 

In addition to this, lifestyle alterations need to be made. This includes adaptation of a healthy diet, regular exercise, maintaining a healthy weight, and quitting smoking are important.

Success Rate of Aortic Stenosis Treatment in India

Both of the treatments have gained higher success and favorable outcomes that are allowed by International standards. For TAVR, around 97% witnessed positive outcomes. For SAVR, 10-year survival stands around 84%. 

Cost of Aortic Stenosis Treatment in India

In India, the cost of treatment for aortic stenosis can vary significantly depending on the type of procedure required. Surgical options, such as aortic valve replacement, can range from USD 6,500 to USD 10,000, depending on the hospital and the complexity of the case. Pre-operative assessments, hospitalization, and post-surgery care also add to the overall expenses, making it essential for patients to consider their options carefully.

Why Choose India for Aortic Stenosis Treatment?

• India is one of the promising regions for this treatment because it provides world-class cardiac experts trained from Germany, the USA, and the UK.
• Alongside this, they have high procedural volumes, advanced infrastructure, and technology like 3D imaging, robotic-based surgery, and hybrid cath labs. 
• They are FDA-approved and CE-certified valves, along with the recommendation from experts in renowned hospitals who maintain Global quality and safety standards.
• India also provides short waiting times, which means it allows patients to receive adequate interventions. 
• In addition to this, medical tourism support services like visa assistance, travel facilitation, and language interpreters make the experience smoother for global patients.
• Post-operative care in India incorporates dietary advice, cardiac rehabilitation, physiotherapy lifestyle counseling, adding to sustainable and faster recovery.

Therefore, in India, hospitals provide a perfect blend of medical excellence, affordability, and compassionate care. 

Required Documents for Patients Traveling to India for Aortic Stenosis Treatment

For international patients planning to undergo aortic stenosis treatment in India, certain documents are required to ensure a hassle-free medical trip. These include:

• Valid Passport: Must be valid for at least six months from the date of travel.
• Medical Visa (M Visa): Issued by the Indian Embassy/Consulate based on medical necessity.
• Invitation Letter from Indian Hospital: A confirmation from the hospital outlining the treatment plan and duration.
• Recent Medical Records: Including X-rays, MRIs, blood reports, and a doctor’s referral from the home country.
• Completed Visa Application Form: Along with passport-size photographs as per specifications.
• Proof of Financial Means: Recent bank statements or health insurance coverage.
• Medical Attendant Visa: Required for a companion or caretaker traveling with the patient.

It's recommended to consult the Indian consulate or your medical facilitator for updated guidelines and assistance with documentation.

Top Doctors in India for Aortic Stenosis Treatment

Some of the top doctors in India, renowned for aortic stenosis treatment, are:

1. Dr. Naresh Trehan, Medanta Hospital, Gurgaon
2. Dr. Upendra Kaul, Batra Hospital and Medical Research Centre, Delhi 
3. Dr. Asim Kumar Bardhan, Apollo Gleneagles Hospital, Kolkata
4. Dr. Cyrus B Wadia, Jaslok Hospital, Mumbai 
5. Dr. Tripti Deb, Apollo Health City Hospital, Hyderabad

Best Hospitals for Aortic Stenosis Treatment in India

Some of the best hospitals in India for Aortic Stenosis Treatment are:

1. Medanta Hospital, Gurgaon
2. Batra Hospital and Medical Research Centre, Delhi 
3. Apollo Gleneagles Hospital, Kolkata
4. Jaslok Hospital, Mumbai 
5. Apollo Health City Hospital, Hyderabad 

Frequently Asked Questions (FAQs)

What are the causes of aortic stenosis?

The main causes of aortic stenosis are congenital heart defects, rheumatic fever, age-related degeneration, high cholesterol, and high blood pressure. 

What is the recovery time after the Aortic Valve replacement?

For SAVR, the recovery time for the patients ranges from 6 to 12 weeks. For TAVR, the recovery time for the patients ranges from 1 to 2 weeks 

What are the types of treatment available? 

The types of treatment available for aortic stenosis are SAVR, TAVR, and balloon valvuloplasty.

What is the difference between SAVR and TAVR treatments?

TAVR is minimally invasive, and the recovery rate is faster, whereas SAVR is open-heart surgery, and the recovery rate is longer. For TAVR, candidates are usually older or high-risk patients, and for SAVR, candidates are younger or low-risk patients. Bioprosthetic valves are used for TAVR, whereas mechanical valves, alongside bioprosthetic valves, are also used in SAVR. 

Is aortic stenosis hereditary?

Not directly, but conditions like bicuspid aortic valves can be hereditary.