TAVR / TAVI in Hyderabad —
Transcatheter Aortic Valve Replacement

Stages of aortic stenosis

The classic symptom triad of severe aortic stenosis

Chest pain (angina) on exertion. Breathlessness — initially on exertion, later at rest. Syncope (blackouts or near-blackouts) — particularly with exertion. Once any of these three symptoms appear, the outlook without treatment is poor — average survival is 2 to 3 years without valve replacement.

What is TAVR and how does it replace the valve?

In conventional open-heart aortic valve replacement, the chest is opened through the breastbone (sternotomy), the heart is temporarily stopped, and a heart-lung machine takes over circulation while the diseased valve is removed and a new valve is sewn in. This is a major operation requiring 6 to 12 weeks of recovery.

TAVR achieves the same result without any of this. A new biological valve — made from bovine or porcine pericardial tissue mounted on a metal frame — is compressed tightly onto a catheter delivery system. This catheter is guided through a blood vessel from the groin to the heart. Once positioned precisely within the diseased native valve under X-ray and echocardiographic guidance, the new valve is expanded — either by balloon inflation or by self-expansion — pushing the diseased valve leaflets aside and immediately taking over valve function. The catheter is then removed. No sutures are placed on the heart. The chest is never opened.

Why TAVR is transformative

Before TAVR was developed, patients with severe aortic stenosis who were too frail or high-risk for open-heart surgery had no effective treatment option. TAVR has changed this entirely — offering valve replacement to patients in their 70s, 80s, and 90s, restoring quality of life and extending survival in a population previously considered untreatable.

Who is a candidate for TAVR?

TAVR is recommended when a patient has severe symptomatic aortic stenosis and the Heart Team determines that TAVR is the preferred approach over surgery. The criteria have expanded significantly since TAVR's introduction:

TAVR is typically recommended for:

• Patients at high or prohibitive surgical risk due to age, frailty, or multiple coexisting medical conditions
• Patients at intermediate surgical risk for whom the Heart Team agrees TAVR offers equivalent or superior outcomes to surgery
• Low-risk patients in selected centres — increasingly being offered TAVR even without elevated surgical risk, based on strong trial evidence
• Patients with a previously implanted surgical bioprosthetic valve that has degenerated — a procedure called valve-in-valve TAVR
• Patients who specifically prefer to avoid open-heart surgery after informed discussion of both options

Factors that may favour surgical valve replacement instead:

1. Young patients (under 65) with long life expectancy where surgical valve durability data is more established
2. Bicuspid aortic valve anatomy in younger patients — specific anatomical consideration, though TAVR is increasingly performed in bicuspid valves
3. Aortic stenosis combined with other cardiac conditions requiring simultaneous surgical correction (e.g. coronary bypass, mitral valve repair)
4. Unfavourable vascular anatomy for catheter access

The Heart Team decision

At AIG Hospitals, every TAVR case is reviewed by a multidisciplinary Heart Team — including Dr. Bhishma Chowdary (interventional cardiologist), a cardiac surgeon, and an imaging specialist. This collaborative process ensures each patient receives the most appropriate treatment for their specific anatomy, surgical risk, and preferences — not a one-size-fits-all recommendation.

Pre-procedure evaluation — what tests are needed?

TAVR requires detailed pre-procedure planning. The following assessments are performed before the procedure is finalised:

How is the TAVR procedure performed? Step by step

The day before

• Admission for pre-procedure blood tests, ECG, chest X-ray, and anaesthesia review.
• Cardiology and cardiac surgery teams review the CT and echocardiogram together to finalise valve size and approach.
• Antiplatelet medications and any anticoagulants are reviewed and adjusted.
• You fast from midnight.

In the hybrid catheterisation laboratory

• You are positioned on the procedure table in the hybrid cath lab — a specialised room combining surgical capabilities with cardiac imaging equipment.
• Anaesthesia is administered — either general anaesthesia (fully asleep) or conscious sedation (relaxed but breathing independently). The choice depends on your anatomy, clinical status, and the team's assessment.
• The groin area is prepared and a large-bore sheath is placed in the femoral artery. Ultrasound guidance is used to access the artery precisely — Dr. Bhishma Chowdary uses large-bore access and closure techniques (Angioseal, Perclose) routinely.
• A temporary pacing wire is placed through a vein into the right ventricle. This allows the heart to be paced rapidly during valve deployment — momentarily reducing cardiac output so the new valve seats accurately.
• The delivery catheter is advanced under live X-ray through the aorta, across the aortic valve, and into the left ventricle. The transesophageal echocardiogram (or intracardiac echo) provides simultaneous real-time imaging from inside the heart.
• The new valve, crimped tightly on the catheter, is positioned precisely at the level of the native aortic annulus. Alignment is confirmed in multiple imaging planes.
• The heart is paced rapidly. The valve is deployed — either by inflating a balloon (balloon-expandable valve) or by controlled self-expansion (self-expanding valve). Deployment takes only a few seconds.
• Rapid pacing is stopped immediately. The new valve begins functioning at once. Echocardiography and angiography confirm correct valve position, gradient reduction, and the absence of significant paravalvular leak.
• The delivery system is removed. The arterial access site is closed with a vascular closure device. The temporary pacing wire is removed (or kept overnight if there are conduction concerns).
• You are transferred to the cardiac intensive care unit or high-dependency unit for monitoring.

Alternative access routes

While transfemoral (groin) access is used in the majority of TAVR cases, alternative routes are available when femoral vessel anatomy is unsuitable:

Types of TAVR valves

Two major generations of TAVR valve systems are in clinical use:

The valve type and size are selected based on your CT annulus measurements, aortic root anatomy, and access vessel dimensions. This decision is made during the pre-procedure Heart Team planning meeting — not in the cath lab.

What happens after TAVR?

In hospital

• Most patients are in the cardiac ICU or HDU for the first 12 to 24 hours for rhythm and haemodynamic monitoring.
• A 12-lead ECG is recorded after the procedure and at 24 and 48 hours to monitor for new conduction block — the most common electrical complication of TAVR.
• If the rhythm remains stable, the temporary pacing wire is removed the morning after the procedure.
• You will be sitting up and eating by the evening of the procedure day (if conscious sedation was used) or the following morning (if general anaesthesia was used).
• Physiotherapy begins the next morning — standing and short walks are encouraged from day one.
• A post-procedure echocardiogram is performed before discharge to confirm valve function, gradient, and the absence of significant leak.
• Discharge is typically on day 3 to 5 after the procedure.

After discharge

• Antiplatelet therapy: Dual antiplatelet therapy (aspirin + clopidogrel) for 3 to 6 months, then aspirin alone lifelong. If you have atrial fibrillation, an oral anticoagulant replaces antiplatelet therapy — discuss with Dr. Bhishma Chowdary.
• Avoid strenuous exertion for 4 weeks. Light walking and household activities are encouraged from the first week.
• Do not drive for 4 weeks after TAVR.
• Dental hygiene is extremely important after any valve procedure. Maintain excellent oral hygiene and inform any dentist that you have had a heart valve replacement — antibiotic prophylaxis may be recommended before dental procedures.
• Follow-up echocardiogram at 1 month, 12 months, and annually thereafter to monitor valve function and gradients.

Will I need a pacemaker after TAVR?

The aortic valve is anatomically adjacent to the heart's electrical conduction system (the His-Purkinje system). TAVR can disrupt this system, causing new bundle branch block or complete heart block — a condition where electrical signals cannot pass from the upper to lower heart chambers.

Approximately 10 to 20% of patients require a permanent pacemaker after TAVR, depending on the valve type, deployment depth, and baseline ECG. Self-expanding valves tend to have slightly higher pacemaker rates than balloon-expandable valves. Factors that increase pacemaker risk include: pre-existing right bundle branch block on ECG, deep valve implantation, heavily calcified annulus, and bicuspid valve anatomy.

If a pacemaker is required, it is implanted before discharge — adding only 1 to 2 days to the hospital stay. Pacemaker implantation in this context is a straightforward procedure and should not be a deterrent to having TAVR.

How long does a TAVR valve last?

This is the question patients and families ask most often. Current evidence from the longest available follow-up studies (8 to 10 years) shows that TAVR valve durability is comparable to surgically implanted bioprosthetic valves for the majority of patients.

The key findings from current data:

• Structural valve deterioration (SVD) — measurable decline in valve function — occurs in approximately 3 to 5% of patients at 8 years.
• Freedom from reintervention is approximately 95% at 8 years in large registry studies.
• Longer-term data (beyond 10 years) is accumulating as the technology matures.

Valve-in-valve TAVR for younger patients

For younger patients receiving TAVR, an important consideration is the possibility of a future valve-in-valve procedure — a second TAVR deployed inside the first when the original valve eventually wears out. This option is specifically planned for during initial TAVR by selecting valve types and sizes that leave adequate space for a future procedure. Dr. Bhishma Chowdary considers valve-in-valve feasibility during all TAVR planning discussions with younger patients.

TAVR versus open-heart aortic valve replacement — a comparison

Two major generations of TAVR valve systems are in clinical use:

Frequently asked questions

What is the difference between TAVR and TAVI?
They are the same procedure — just different names. TAVR stands for Transcatheter Aortic Valve Replacement. TAVI stands for Transcatheter Aortic Valve Implantation. The term TAVR is more commonly used in the United States, while TAVI is preferred in Europe and India. Both refer to the same catheter-based valve replacement technique without open-heart surgery.

Am I too old for TAVR?
No. TAVR was specifically developed for elderly patients who cannot safely undergo open-heart surgery. Patients in their 80s and even 90s have successfully undergone TAVR with excellent outcomes. Age alone is never a reason to deny TAVR — what matters is the overall clinical picture, functional status, and expected benefit. Dr. Bhishma Chowdary has experience performing TAVR in elderly patients including frailty-adjusted planning.

Is TAVR done under general anaesthesia?
Not necessarily. TAVR can be performed under conscious sedation — a combination of local anaesthesia at the groin entry site and intravenous sedation that keeps you deeply relaxed but breathing independently. This approach (sometimes called the “minimalist” protocol) is increasingly common, avoids the risks of general anaesthesia, speeds recovery, and often allows discharge a day earlier. General anaesthesia is used when anatomy or clinical factors require it. Your anaesthesiologist and Dr. Bhishma Chowdary will determine the best approach for you.

How will I know if my aortic stenosis is severe enough to need TAVR?
Severity is assessed with echocardiography. Key parameters include the valve area (severe when less than 1.0 cm²), the mean pressure gradient across the valve (severe when above 40 mmHg), and the peak velocity (severe above 4 m/s). The presence of symptoms — chest pain, breathlessness, or blackouts — is the critical trigger for recommending treatment. Your echocardiogram report will state the severity grade, and Dr. Bhishma Chowdary will explain what this means for your specific situation.

What is paravalvular leak and is it a problem after TAVR?
Paravalvular leak (PVL) is a small gap between the new TAVR valve and the native aortic annulus, allowing a trace of blood to leak back around the valve. Mild PVL is common after TAVR and does not significantly affect outcomes. Moderate or severe PVL is uncommon with modern valve systems and careful sizing, but when present it can require a post-dilatation balloon inflation or occasionally valve-in-valve treatment. Meticulous pre-procedure CT planning and accurate annulus sizing by Dr. Bhishma Chowdary minimises this risk.

Can TAVR be combined with treatment for coronary artery blockages?
Yes. If significant coronary artery disease is found on the pre-TAVR coronary angiogram, coronary angioplasty and stenting is typically performed in the weeks before TAVR — allowing the coronary arteries to be treated first and the heart to stabilise before valve replacement. In selected cases, angioplasty and TAVR may be done in the same session. The sequencing is determined by the Heart Team.

What are the signs that my TAVR valve is not working properly?
Return of symptoms — breathlessness, chest discomfort, dizziness, or reduced exercise tolerance — after an initial period of improvement should prompt immediate contact with Dr. Bhishma Chowdary. Annual echocardiography after TAVR monitors valve function, gradients, and leaflet integrity. Sudden worsening of symptoms, fever, or unexplained weight gain should be reported promptly as they can indicate valve-related complications requiring urgent assessment.

How soon will I feel better after TAVR?
Most patients notice improvement in breathlessness within the first week after a successful TAVR as the heart adjusts to the new valve. Energy levels and exercise capacity typically improve progressively over 4 to 12 weeks. Patients who have had longstanding severe aortic stenosis with reduced heart function may take 3 to 6 months to see the full benefit as the heart muscle recovers from years of increased strain.

I had open-heart surgery years ago — can I still have TAVR?
Yes, and in fact prior cardiac surgery can make TAVR even more attractive by avoiding the risks of redo sternotomy — which is technically more complex and carries higher surgical risk than a first operation. The presence of previous bypass grafts or valve surgery is specifically evaluated in the pre-TAVR CT and Heart Team planning. Prior surgery alone is not a contraindication to TAVR.

Why choose Dr. Bhishma Chowdary for TAVR at AIG Hospitals, Hyderabad?

• DM Cardiology from Amrita Institute of Medical Sciences, Kochi — specialist structural heart training.
• Dedicated structural heart programme at AIG Hospitals, Gachibowli — one of Hyderabad's leading interventional cardiac centres.
• Hybrid catheterisation laboratory with advanced imaging, surgical backup, and full cardiac ICU support.
• Experience in complex structural interventions: TAVR, MitraClip (transcatheter mitral valve repair), TMVR, and transcatheter mitral valve-in-valve — presented at TCTAP international conference.
• Routine large-bore ultrasound-guided vascular access and closure (Angioseal, Perclose) — minimising access site complications.
• Multidisciplinary Heart Team approach — every TAVR case reviewed jointly with cardiac surgery before proceeding.
• Conscious sedation (minimalist) TAVR protocol for eligible patients — faster recovery, reduced hospital stay.
• Comprehensive follow-up programme with annual echocardiography and long-term valve surveillance.
• Fluent consultations in English, Hindi, and Telugu.

Book a TAVR consultation at AIG Hospitals, Hyderabad

If you or a family member has been diagnosed with severe aortic stenosis, or if you have symptoms such as breathlessness, chest pain, or blackouts and have been told your heart valve is narrowed, contact Dr. Bhishma Chowdary's clinic at AIG Hospitals for a specialist structural heart consultation.

Call: +91-9000352998

Email: bhishmachowdary@gmail.com

Location: AIG Hospitals, Gachibowli, Hyderabad — 500032

Clinic hours: Monday to Saturday, 10:00 AM to 4:00 PM

Related services

• Coronary Angiogram (pre-TAVR coronary assessment) — /coronary-angiogram
• Coronary Angioplasty (combined with TAVR when needed) — /coronary-angioplasty
• ASD Device Closure (structural heart) — /asd-device-closure
• Pacemaker Implantation (may be needed after TAVR) — /pacemakers
• TEVAR (thoracic aortic repair) — /tevar
• Advanced Minimally Invasive Procedures — /advanced-minimally-invasive-procedures
• All services