Question 1

What is aortic valve replacement and when is it needed?

Accepted Answer

Aortic valve replacement (AVR) is a surgical procedure where a diseased aortic valve is replaced. Aortic stenosis (narrowed valve) or aortic regurgitation (leaking valve) are the two conditions most commonly requiring replacement.

Question 2

What is the difference between a mechanical valve and a biological valve?

Accepted Answer

Mechanical valves are carbon-based and exceptionally durable, often lasting several decades, but require lifelong anticoagulation. Biological valves (bioprostheses), made from animal tissue (pig or cow), eliminate the need for prolonged blood thinners but typically last 10–15 years depending on the age at implantation.

Question 3

What are the different ways of replacing the aortic valve?

Accepted Answer

There are four options: (1) Open surgery — chest opened through the middle; (2) Minimally invasive surgery (MICS) — valve replaced through a small cut between the ribs; (3) TAVI/TAVR — catheter-based replacement via the groin, for older or high-risk patients; (4) Robotic replacement — robot-assisted via small 8 mm ports on the right chest, suitable for all valve types.

Question 4

Is robotic aortic valve replacement available in India?

Accepted Answer

Yes. Robotic aortic valve replacement is available in India at Apollo Hospital, Bengaluru, performed by Dr Sathyaki Nambala. It is routinely performed but is not widely available at most hospitals across the country.

Question 5

Is robotic aortic valve replacement better than TAVI?

Accepted Answer

Robotic aortic valve replacement is the most advanced surgical technique for replacing the aortic valve and is suitable for all patients fit for surgery, including those with complex anatomy or heavily calcified valves. TAVI is best suited for older or high-risk patients who are not fit for surgery.

Question 6

What is TAVR/TAVI and is it available in India?

Accepted Answer

TAVR (Transcatheter Aortic Valve Replacement) and TAVI (Transcatheter Aortic Valve Implantation) are two names for the same minimally invasive procedure performed without opening the chest, via a small arterial incision — usually in the groin. It is generally indicated for older or surgically high-risk patients and is available in India.

Question 7

Which is better — a TAVR valve or a surgical valve?

Accepted Answer

Surgical valves are more durable than TAVI valves. In younger patients, surgical bioprosthetic valves last significantly longer, which has a major impact on life expectancy and the need for repeat interventions. TAVI valves are best suited for patients over 75 years who are unfit for surgery.

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