An 89-year-old man with a rare heart anatomy recently underwent a heart valve replacement procedure. His surgeon chose to use a filter to protect him from suffering a stroke following the procedure.
G. Sengottuvelu, senior consultant and intervention cardiologist at Apollo Hospital, opted for transcatheter aortic valve implantation (TAVI) procedure as the patient had several co-morbidities that involved his liver, lung and kidney. The patient presented with bovine arch which added to the complication. Normally, the aortic arch will branch into three vessels. In the patient, the carotid artery had branched from one of the vessels instead of from the aorta, making it more challenging, Dr. Sengottuvelu said.
The patient had undergone an aortic valve replacement in 2006 that had since failed.
“When we do TAVI we have to pass through the main aorta. In the elderly, the valve is already degenerated, calcified and the valve would have thickened. When we deploy a stent there is a chance that it will scrape the blood vessel and some material will move through the blood stream. Very commonly they go to the brain and cause stroke,” he said.
Dr. Sengottuvelu decided to use a new filter that had recently been introduced in India from the U.S. The FDA-approved filter is placed in the blood vessels that go to the brain during the procedure, thus reducing chances of clinical and asymptomatic stroke.
The specialist said recent studies estimated approximately 3% to 6% of patients experienced a clinically apparent stroke within 30 days of TAVI or transcatheter aortic valve replacement.
According to him, though normally the filter helped block 90% of the particles, the patient’s rare anatomy ensured that filters were placed in all the vessels carrying blood to the brain and thus achieve complete prevention of particles entering the blood stream in the brain and the risk of embolism resulting in stroke.
The cost of the procedure would depend on the type of valve used while the use of filter would increase the cost by an additional ₹3 lakh, Dr. Sengottuvelu added.
