TAVI vs Surgical Aortic Valve Replacement: How Doctors Decide

As far as cardiology goes, the basic screening tools would be a thorough echocardiography and ECG, blood tests like lipid profiles, CRP values, and HbA1c for underlying diabetes mellitus, and sometimes even a stress test to dig out coronary artery disease. These are classical tests conducted in most people who have passed the age of 40 or 45, and especially the elderly — a thorough echocardiography usually digs out the necessary information, and then we start acting on the preventive aspect.

They should be in touch with us and send their CVs. They should be ready to face a physical interview, maybe online or coming here, and then we appraise them that they're fit to be inducted into our program. There are some local country regulatory bodies that clear their CVs — that part is also done by BLK. There are minimal fees involved, and they have to make their local arrangements for stay, food and clothing — and people have really been benefited by being with us in our lab, and we give them hands-on experience at some stage.

It's difficult to comment on this. It could be a vascular lump or some kind of arteriovenous fistula in the palm, but one has to do a thorough CT scan, a contrast CT, or maybe a DSA, and then only one can find out as to what is the reason — and can also fix it by minimally invasive technique, putting in a covered stent or coils accordingly. But one has to first prove what we're dealing with; I can't say on this bare information.

In India, open heart surgeries are cheaper than the West because the logistics of hospital management, bed and other things lasting six to seven days don't cost as much. Surgery is definitely cheaper here, and given that a lot of innovation goes into preparing minimally invasive procedures, those are at a slightly higher cost, or at least at par with the surgical technique. TAVI in India compared to the surgical procedure is about double the cost — in the West it could even be less than the surgical procedure, because their overheads and surgical procedures are much more expensive. In India we could offer this TAVI procedure for as little as $25,000, which could be perhaps the least in the world.

TAVI is all about planning. Doing TAVI is not a great job — it doesn't need very high level skills, but the whole energy should be dedicated to planning before you embark on the procedure. That planning is a thorough CT scan, which could be conducted locally and sent to us, and then we can plan around that CT finding as to which valve is required and what we're going to face in terms of coronary occlusion, groin complications or stroke. Mortality in TAVI can be very high if you are not careful about the groin — you should know pretty well how to manage it. The whole thing is around planning, planning, planning, planning.

The STS-PROM score is calculated from a patient's overall clinical parameters to grade surgical risk as high, intermediate or low, and it guides the choice between TAVI and surgical aortic valve replacement along with factors like annular calcium and femoral access.

Surgery is generally preferred for younger patients, those with a bicuspid aortic valve, patients with unfavourable femoral access for TAVI, those with a low coronary ostium height, and patients needing bypass grafting alongside valve replacement.

A porcelain aorta, where the aorta is heavily calcified and difficult to operate on, is one of the factors that makes TAVI the better option, since it avoids the risks of surgery on a calcified aorta.

Prior chest radiation makes reopening the chest for surgery more difficult and risky, which is one of the factors that favours TAVI over surgical aortic valve replacement.