Dr. Kirtiman Singh

Percutaneous Valve Therapy

​

 

Transcatheter Aortic Valve Replacement (TAVR)

TAVR is minimally invasive percutaneous procedure that replaces the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve site. Usually valve replacement requires an open heart procedure with a “sternotomy”, in which the chest is surgically opened for the procedure. In this procedure, a catheter is placed in the femoral artery (in the groin) similar to angioplasty, and guided into the chambers of the heart.

A compressed tissue heart valve is placed on the catheter and is positioned directly inside the diseased aortic valve. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

 

 

Transcatheter Mitral Valve Repair (TMVR)

TMVR, also known as transcatheter mitral valve replacement is a way of replacing the mitral valve in the heart without the need for conventional open-heart surgery.

 

MitraClip

MitraClip is a device used to repair leaky mitral valve – a condition called mitral regurgitation. Mitraclip device is inserted and positioned at the leaking portion of the valve through transcatheter technique. Unlike surgery, the MitraClip procedure does not require opening the chest and temporarily stopping the heart. Instead, doctors access the mitral valve with a thin tube (called a catheter) that is guided through a vein in your leg to reach your heart. The procedure is less invasive than traditional open-heart surgery and patients are usually released from the hospital within 2 to 3 days. Patients are known to experience improvement in their symptoms of mitral regurgitation and quality of life soon after the procedure.

​

 

 

Percutaneous Coronary Intervention (Stenting)

 

 

Angioplasty

Coronary angioplasty also called PCI or PTCA – is a minimally invasive procedure that helps treat coronary heart disease (blocked coronary arteries) by improving the blood supply to the heart muscle, through widening and opening of the narrowed coronary arteries . It is used to stop heart attacks in progress, treat chest pain (angina), and restore blood flow through the coronary arteries.

 

Intracoronary Imaging IVUS, OCT

ntracoronary imaging techniques (intravascular ultrasound (IVUS) and optical coherence tomography (OCT)) are routinely available to complement angiography in the management of coronary artery disease. Both IVUS and OCT are superior to angiography for quantification of vessel dimension and thus critically helpful in guiding coronary angioplasty (percutaneous coronary intervention (PCI)) and stent implantation

 

Bioresorbable Vascular Scaffold

Bioresorbable vascular scaffolds (BVS) are designed to provide mechanical support and drug delivery similar to the DES (drug eluting stent), followed by complete resorption over several years. Recent trials have demonstrated clinical non-inferiority of the BVS compared with contemporary DES. BVS is designed to help open up a blocked artery in the heart and restore blood flow to the heart muscle. BVS gradually dissolves once the artery can stay open on its own, potentially allowing the blood vessel to function naturally again.

 

Intracoronary Physiology FFR

Fractional Flow Reserve (FFR) a golden technology is now frequently used to determine if a cardiac patient really needs a stent or bypass surgery or can be kept only on medicines avoiding any procedure. FFR is defined as the ratio between distal coronary pressure and aortic pressure, both measured simultaneously at maximal hyperemia.

The difference in the pressure between these two points will give information on the severity of the block, and help to determine if the narrowing (block) needs to be cleared using procedures such as stenting, or whether it can be treated using only medicines. This scientific and evidence based procedure is beneficial to the patient as FFR technology not only saves lives while avoiding unnecessary surgery but also helps patients to save cost.

 

Transradial Intervention

Transradial intervention (TRI) is a percutaneous coronary intervention (PCI) procedure done using the hand (wrist). In TRI, a catheter is inserted via the radial artery in the wrist to deliver stents to narrowed or occluded blood vessels such as coronary arteries. This patient friendly approach facilitates less pain, less bleeding and early discharge.

Conversely, catheters may be introduced via transfemoral intervention (TFI), that is, through an artery in the upper leg. Such TFI procedures were once the standard for this type of treatment. Continued development of balloon catheters and stents, however, has enabled access through the smaller vessels in the wrist, or TRI. And, compared to TFI, transradial intervention seems to place less mental, physical, and economic burden on patients, which has led to this procedure becoming the new standard.