Dr. Tyrone J Collins is currently Director of Interventional Cardiology, Ochsner Clinic, and affiliated with Ochsner Medical Foundation New Orleans, Louisiana, USA. Dr. Collins graduated from Meharry Medical College in 1979 and has been in practice for 39 years. Dr. Collins also specializes in Cardiology and Internal Medicine. Excerpts from his conversation with FM
Do you think TAVR will replace the conventional open heart valve replacement surgery? If so, why?
No, I think TAVI (TAVR) will always be an alternative to surgery for patients in the US and all over the world. Most patients get surgery. TAVI is an alternative for patients at high risk. For moderate risk patients, they can go for surgery or TAVI. We really don’t know what is going to happen for patients at low risk for surgery. I would suspect that patients with low risk will continue to have surgery instead of TAVI unless we have evidence that, in long term, TAVI valves will last as long as surgery valves.
Currently, which are the heart valves that can be replaced by trans-catheter devices?
Right now, the majority of the patients who undergo TAVI are getting their aortic valves replaced. The pulmonary valve can be placed in pediatric patients. The replacement of other valves like tricuspid and mitral valves is still under investigation.
What is the level of acceptance of TAVI among the interventionists in the US?
It is widely accepted by the interventionists in the US. A lot of interventionists want to do TAVI. But there are lots of reasons that TAVI is not available in all the hospitals in the US. I think most doctors would be willing to do TAVI or send their patients for TAVI. But probably, if I had to guess, only 10% are actually doing it. It’s a small number.
As a procedure, can TAVI be used across all sorts of patients with valve dysfunction or is its use limited to patients who are not fit to undergo an open heart surgery?
Certainly for patients who can undergo open heart surgery, TAVI is an alternative for them. TAVI has a spectrum of patients that can get the valve. We don’t know how long the TAVI valves last, because we have not done it long enough to have that data. Patients who are not at high surgical risk can certainly have TAVI. We don’t know what will happen to those who are at low surgical risk. There are trials going on right now to gather that information.
What are the possible risks with TAVI procedure?
The first thing that can happen with TAVI, like any other operation, is that you can die. There is a possibility of stroke; there is a possibility of needing a pacemaker, bleeding complications, infections. The usual and the biggest concerns that we have with most TAVI patients is whether they will be needing a pacemaker or not.
TAVI is minimally invasive. It does not involve anaesthesia or open surgery and the recovery time is extremely short. Still, it is yet to be widely available at Indian hospitals? What could be the possible reasons according to you?
The biggest drawback, I would anticipate here in India, is the cost of the valves. A valve costs probably over 30,000 US dollars in India. Unless we develop a valve that is not so expensive, I think its acceptance worldwide will be low.