Country`s first valve replacement minus open heart surgery

Cardiac patients with a diseased aortic valve can now look beyond surgery to save their hearts.

Updated: Jul 30, 2010, 18:41 PM IST

New Delhi: Cardiac patients with a
diseased or narrowed aortic valve can now look beyond surgery
to save their hearts, with a new procedure designed for people
unfit for surgery set to be introduced in India.

The aortic valve lies between the left ventricle of
the heart and the aorta, and a problematic valve can obstruct
the blood flow out from the heart.

The ailment then needs to be corrected through a
replacement of the valve -- a procedure that hitherto had no
option but surgery in India -- leaving the patients who are
deemed high-risk for surgery with no alternative procedure to
save their lives.

But a group of doctors in Medanta Medicity, Gurgaon,
are set to perform the first percutaneous valve replacement in
India that comes minus an open heart surgery, and hence cuts
the risks associated with it for very old people and those
considered high-risk with lung or kidney ailments.

"Until now there was no alternative or replacement to
surgery for aortic valve defects and we were unable to treat
patients in whom surgery was not possible," says Dr Praveen
Chandra, chairman of interventional cardiology at Medanta
Heart Institute.

In the procedure called Percutaneous Aortic Valve
Implantation or PAVI, a valve is taken through a stent
inserted inside a small opening made in the groin.

The artificial valve is then taken through lower limb
blood vessels to the heart where it is fitted under X-ray

"The procedure takes one hour and the patient can be
discharged in 3 to 4 hours, unlike in a full fledged surgery
which takes at least 4-5 hours and requires some three months
for the patient to fully recover," he said.

The procedure will be performed next month by a group
of doctors from the hospital with some six surgeons from
Europe, who are well-versed with the procedure, assisting

"Existing procedures have their own role and utility,
but there are limitations for patients who are quite old and
frail, and we are not able to remove their aortic blockage
through surgery. For patients who can`t take a major
operation, it is a crucial alternative," says Dr Naresh
Trehan, Chairman of Medanta Medicity.

The procedure is done in a fashion similar to
angioplasty, with a small puncture in groin vessels with or
without anaesthesia depending on the condition of the patient.

The procedure is an evolving one and experts say there
is limited data available about it, given the fact that
experience available on the subject is less.

Another disadvantage is its high cost. The procedure
will cost Rs 12 lakh as against the surgical procedure where
patients need to spend Rs three lakh roughly.

"We believe over a period of time when experience and
popularity of the procedure grows, costs will get lesser. And
once Indian surgeons become well versed in the practice, we
will not need to fly in experienced foreign doctors, the way
we are doing it now," Chandra says.

The procedure is still very young and its inception is
traced backed to the year 2000. Since then, a total of 10000
percutaneous aortic valve implants have been done worldwide
with more than 95 per cent success rate.

Chandra says patients are being enrolled and screened
to test their suitability for it as they await clearance from
the government for the surgery being performed for the first
time in the country.


London: Endorsing David Cameron`s views on Pakistan exporting terror, a leading British newspaper on Friday said the Premier`s comments were "startling" but basically correct to be so critical of that country while in India.

Describing Cameron`s India visit as "The Grand Tour", The Times said in an editorial that his first major international visits were not flawless, but his objectives were well chosen and his performances, with one exception, assured."

Cameron had on Wednesday said in Bangalore that Pakistan should not have ties with groups that promote the export of terror to Afghanistan or India.

"The most obvious feature of Cameron`s tour was that each leg had a clear objective. In the United States, the Prime Minister sought to re-establish the special relationship after the slightly awkward dealings that Gordon Brown had with President Barack Obama.

"In Turkey, Cameron aimed to show that his government saw the Turks as an important ally, and try to deter the Turkish government from dallying with Iran. And in India virtually the entire senior tier of the government turned out to show Indians that Britain was serious about building economic and political links," the newspaper said.

It said Cameron`s comments on Pakistan was "startling, but basically correct, to be so critical of Pakistan when in India."

Responding to Indian sentiment about its neighbour`s security policy was one of the few ways that Cameron could be certain to gain the attention of his audience.

It said the Indian initiative, in particular, was long overdue.

"India`s rise will be of increasing importance to this country`s economic and international policy. It is very much in our national interest that closer links should be forged, and we are very late in forging them."

The paper said it was right to address Turkish concern about conditions in Gaza. But it was wrong, in fact and especially in tone, to describe Gaza as a "prison camp".

It said Cameron has made a confident start on the international stage. "Now we must wait to see how he responds to his first important foreign policy test. For such a test will surely come."

In a report, The Times said Cameron tempered his criticism of Pakistan last night as he left India having set the goal of doubling trade with the country in five years.

Bureau Report