Septuagenarian with rare blood disorder undergoes 1st aortic valve replacement

Hyderabad: A 79-year old man with a rare blood disorder that caused bleeding even without any injury, here, has become the first patient in India to undergo transcatheter aortic valve replacement.

The man was presented to doctors at Medicover Hospitals with hemophilia -- a significant bleeding disorder caused due to the deficiency of clotting factors in the blood. He also had severe aortic stenosis -- narrowing of the heart valve -- due to which the valve that regulates the flow out of the heart got jammed. He also had significant breathing difficulty.

"Risk of bleeding during surgery as well as a severe lung disease placed him at a high risk for surgery for valve replacement," said Dr. Anil Krishna, Chairman and Managing Director, Medicover India, in a statement.

As a result, the doctors opted for a transcutaneous aortic valve replacement, meaning that the aortic valve can be replaced without any incision on the chest, but is done through the groin.

"This would vastly reduce the risk of fatal bleeding and was a very quick procedure with a short hospital stay and quick recovery," Krishna said.

He was evaluated for TAVR (Trans Catheter Arotic Valve Replacement) - a procedure that replaces a diseased aortic valve with a man-made valve, but the doctors found that his aorta was narrowed below the kidney blood vessels and his artery in the groin on the right side had significant narrowing.

They then decided to go ahead with the valve replacement from the left groin.

"Because he didn't have much calcium in the valve, he didn't need a prior balloon dilatation of the valve and we could go ahead with a direct implantation of the valve. His valve position was perfect, obviating the need for a pacemaker. The pressure gradients across the aortic valve became normal as soon as the valve was implanted and this is a measure of immediate success of the procedure," Dr M.S.S. Mukharjee, interventional cardiologist who performed the surgery, in the statement.

However, the post procedure period was not that smooth. The patient had bleeding from the groin, he started bleeding from the urinary tract, and became oxygen dependent for some time.

"We gave him recombinant factor 8 procured from Hemophilia society before the procedure and repeated the dose after twelve hours. We had to repeat the twin doses after one day. All the complications were then managed," Mukharjee said.

The patient is now discharged and comfortable is a miracle of modern medicine. TAVR is a procedure which avoids a major surgery and can safely be done in patients with extreme co-morbidities also, he noted.