Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Oct 8, 2026 · View LinkedIn profile

Aortic valve sclerosis means the aortic valve has thickened or picked up some calcium, but it still opens well and blood flows through it normally. It is not aortic stenosis, and it does not need a valve procedure. It does deserve attention, for two reasons: a small share of sclerotic valves narrow over the years, and sclerosis is linked with a higher risk of heart attack and stroke.

If your echo report says “aortic valve sclerosis”, “sclerosed aortic valve” or “AV thickened, opening normal”, this article explains what it means and what to do next.

What does aortic valve sclerosis actually mean?

The aortic valve sits between the heart’s main pumping chamber and the aorta, the large artery to the body. Its three thin flaps, called leaflets, open with each heartbeat and close to stop blood flowing back.

With age, these leaflets can thicken. Small deposits of calcium settle on them. On an echo, they look brighter and thicker than a young person’s valve. That is sclerosis.

The key word is “still”. The leaflets are thicker, but they still swing open fully. The echo measures how fast blood moves through the valve, and in sclerosis that speed stays close to normal. Nothing is blocked.

It is very common. In the Cardiovascular Health Study, which followed older Americans for years, Otto and colleagues found sclerosis in 29% of 5,621 people aged 65 or above. A 2014 review of 22 studies by Coffey and colleagues found it in 9% of people in a study with an average age of 54, rising to 42% in a study with an average age of 81.

How is it different from aortic stenosis?

Aortic stenosis is the next stage. The leaflets become stiff enough that they no longer open fully. Blood has to squeeze through a smaller opening, so it speeds up, and the heart has to push harder.

The echo draws the line using that speed, the pressure difference across the valve and the area of the opening. When those numbers move out of the normal range, the report changes from “sclerosis” to “mild aortic stenosis”. Our Hindi guide to reading an echo report for aortic stenosis lists the exact cut-off for each grade.

Sclerosis is the early, silent stage of the same disease. Not everyone moves on from it, and those who do usually take years.

Is aortic valve sclerosis dangerous?

On its own, no. The valve is working, and sclerosis does not cause breathlessness, chest pain or fainting. If you have those symptoms, the cause lies elsewhere and still needs finding.

The concern is what sclerosis signals. There are two separate risks.

Risk 1: it can progress to stenosis

Most sclerotic valves never become a problem. Some do. The Coffey review found that 1.8% to 1.9% of people with sclerosis developed aortic stenosis each year.

In a study by Cosmi and colleagues of 2,131 patients with a thickened valve, 15.9% developed aortic stenosis. Severe stenosis developed in 2.5%.

Those numbers cut both ways. A small yearly rate is reassuring. Over 10 or 15 years it adds up, so one reassuring echo at 65 is not the end of the story.

Risk 2: it is a marker of heart and artery disease

In the Otto study, people with sclerosis had about a 50% higher risk of dying from heart disease and of having a heart attack over five years than people with normal valves. That held even after allowing for age and sex, and again after allowing for other risk factors.

The Coffey review found the same pattern: a 68% higher risk of coronary events, 27% higher risk of stroke and 69% higher risk of death from heart disease.

Why would a working valve carry that risk? The calcium on the valve builds up through a process much like plaque in the arteries. The valve is not causing heart attacks. It is a visible sign that the same process may be at work in the coronary arteries.

What raises the chance of progression?

In the Cardiovascular Health Study, Stewart and colleagues found that the factors linked with sclerosis look a lot like coronary risk factors:

• Age, with roughly double the risk for every 10 years
• Male sex, about twice the risk
• Current smoking, about 35% higher risk
• High blood pressure, about 20% higher risk
• High LDL cholesterol and high lipoprotein(a), a genetic form of cholesterol

The Cosmi study added one echo finding: calcium in the ring of the mitral valve (mitral annular calcification) was the only factor that independently predicted progression to stenosis in that group.

Two other causes of a “thickened” valve matter in India. A valve with two leaflets instead of three, a bicuspid aortic valve, tends to thicken and narrow 10 to 20 years earlier than a normal one. Old rheumatic fever can also thicken the aortic valve, usually alongside changes in the mitral valve. In Rajasthan I still see both. When a report mentions sclerosis in someone under 50, I check whether the valve has two leaflets or three, and whether there are rheumatic changes.

What should you do if your echo shows aortic sclerosis?

No medicine is needed for the valve itself. Look after the rest of your heart, and keep an eye on the valve.

Treat the risk factors that matter for your arteries. Keep blood pressure in the range your doctor sets. Stop smoking completely. Control diabetes. Get your cholesterol checked. I do not prescribe a statin for the valve, but I do prescribe one when the overall heart risk calls for it.

Get a repeat echo. There is no single guideline interval for sclerosis alone. When the valve is otherwise fine and the person has no symptoms, I usually repeat the echo after about two to three years. I bring it forward if the doctor hears a new or louder murmur, or if the valve has two leaflets.

Know the symptoms that should bring the visit forward. Do not wait for the scheduled echo if you notice:

• Breathlessness on walking or climbing stairs that is new or getting worse
• Chest tightness or heaviness during effort
• Dizziness, light-headedness or fainting during or just after effort

I do not ask patients with sclerosis alone to cut back on walking or exercise. The valve is not narrowed, so there is no reason to restrict yourself.

When I see a patient with sclerosis in the OPD, the valve is usually the shortest part of the conversation. I listen for the murmur and look at the echo for the leaflets and the mitral ring. Then I spend most of the time on blood pressure, cholesterol, sugar, smoking. That is where the real risk sits.

What does not work?

Nothing reverses calcium on a heart valve. No diet, supplement or ayurvedic preparation has been shown to dissolve it. Be wary of anyone who promises otherwise.

Statins are the obvious question, and they have been tested. In the SALTIRE trial, 155 patients with calcific aortic stenosis took high-dose atorvastatin or a placebo. LDL cholesterol fell by more than half on the statin, yet the valve narrowed at the same speed in both groups.

The larger SEAS trial gave 1,873 patients with mild or moderate stenosis either simvastatin plus ezetimibe or a placebo. Valve replacement was needed just as often in both groups. But the treated group had fewer heart attack-type events (148 against 187 patients).

That is the honest summary. A statin will not protect your valve. It may protect your arteries, which is the reason to take one when your doctor advises it. These trials were in stenosis, not sclerosis, and no trial has shown any medicine stops sclerosis from progressing.

When should you see a structural heart specialist?

Sclerosis alone does not need a TAVI specialist. I tell patients this plainly: you will not be offered a valve procedure for sclerosis, and you should not be.

See a structural heart cardiologist if:

• A later echo shows the valve has moved into mild, moderate or severe aortic stenosis
• The valve has two leaflets, or there are rheumatic changes
• You develop any of the symptoms listed above

If stenosis does develop and becomes severe, the treatment options include surgical valve replacement and TAVI, a valve replacement through a tube in the leg artery. Our guide to aortic stenosis symptoms and treatment covers that stage in detail, and the TAVI eligibility guide explains who qualifies. Most people with aortic valve sclerosis will never need either.

To have your echo reports reviewed, you can book a consultation with Dr. Prem Ratan Degawat in Jaipur.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a consultation

FAQs

Is aortic valve sclerosis dangerous?

The sclerosis itself does not harm the heart, because the valve still opens normally. It matters for two reasons. A small share, about 2% a year in pooled studies, progress to aortic stenosis. It is also linked with a higher risk of heart attack and stroke, so your other heart risk factors need attention.

Can aortic valve sclerosis be reversed?

No. Calcium on the valve does not dissolve with diet, supplements or medicines. Statins lower cholesterol but did not slow valve narrowing in the SALTIRE and SEAS trials. What you can change is your overall heart risk, which is where most of the danger linked with sclerosis lies.

Does aortic sclerosis need surgery or TAVI?

No. Surgery and TAVI are for severe aortic stenosis, usually with symptoms. Sclerosis means the valve still opens normally, so there is nothing to replace. If a later echo shows the valve has narrowed to a severe degree, the question of valve replacement comes up then.

How often should I repeat the echo?

There is no fixed guideline interval for sclerosis alone. For a three-leaflet valve with no symptoms, I usually repeat the echo after two to three years. It should be sooner if a new murmur is heard, the valve has two leaflets, or you develop breathlessness, chest tightness or dizziness on effort.

What is the difference between aortic sclerosis and mild aortic stenosis?

In sclerosis the leaflets are thickened but open normally, and blood moves through the valve at near-normal speed. In mild stenosis, the opening has started to narrow and the speed of blood through it has risen above normal. The echo report states which one it is, based on measured numbers.

The post Aortic Valve Sclerosis vs Aortic Stenosis: When a Thickened Valve Becomes a Problem appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Sep 27, 2026 · View LinkedIn profile

There is no fixed upper age limit for TAVI. People in their late 80s and 90s have the procedure when the valve is the main thing holding them back. What decides it is frailty, memory, other illnesses and whether the procedure can realistically give back good years, not the date of birth.

That is also the honest answer to the question families ask most often in clinic: “Is my father too old for this?” Sometimes the answer is no. Sometimes the answer is that the valve is not his biggest problem any more.

Why is age the wrong question?

Two people aged 84 can be completely different patients. One walks to the market every morning and manages her own medicines. Another has been mostly in bed for a year after a stroke. The birth certificate is identical; the likely result of a valve procedure is not.

Guidelines have also moved. The 2025 ESC/EACTS valve guidelines lowered the age from which TAVI is generally recommended over surgery from 75 to 70. That is a lower threshold, not an upper one. Nothing in these guidelines closes the door at 80 or 85.

For the general criteria, our TAVI eligibility guide covers who qualifies. This article is about the older end of that range.

What does frailty actually mean?

Frailty is a loss of physical reserve. A frail person copes with daily life, but a fall, an infection or a hospital stay can tip them into a lasting decline. It is measured, not guessed from how someone looks in a wheelchair at the OPD door.

The largest study on this, the FRAILTY-AVR study by Afilalo and colleagues, followed 1,020 patients with a median age of 82 who had TAVI or surgical valve replacement. Depending on the scale used, between 26% and 68% of them were frail.

A short four-item tool, the Essential Frailty Toolset, predicted outcomes best. It checks:

• Leg strength, by timing how quickly the person can stand up from a chair several times
• Memory and thinking, with a brief bedside test
• Anaemia, from a routine blood count
• Albumin, a blood protein that falls with poor nutrition

Frail patients on this tool had about 3.7 times the odds of dying within a year of the procedure, and higher odds of worsening disability. That does not mean frail patients should never have TAVI. It means frailty has to be part of the conversation, with numbers rather than impressions.

Other checks commonly used alongside it include walking speed over a short distance, recent weight loss, and whether the person needs help with basic daily tasks.

What happens if severe aortic stenosis is left untreated?

Once severe aortic stenosis causes symptoms, it does not stay still. Breathlessness, chest pain on effort and fainting are signs that the heart is struggling to push blood through the narrowed valve.

The clearest evidence comes from the PARTNER trial cohort reported by Leon and colleagues in 2010. It enrolled 358 patients with severe aortic stenosis whom surgeons judged unsuitable for open surgery. At one year, 50.7% of those given standard medical treatment had died, compared with 30.7% of those who had TAVI. Among survivors, 58.0% of the medically treated group still had severe symptoms, against 25.2% after TAVI.

The same trial also recorded more major strokes and vascular complications at 30 days in the TAVI group. Devices and techniques have changed since 2010, but the basic point holds: untreated symptomatic severe aortic stenosis carries a high risk within one to two years. Medicines can ease fluid build-up, but they do not open a narrowed valve.

How is an 80- or 85-year-old assessed?

The valve tests are the same as for any TAVI patient, starting with an echo and a CT scan. Our guide to reading an echo report (in Hindi) explains the numbers. For an older patient, the conversation around those tests matters as much as the tests.

Beyond the valve itself, the assessment looks at five things:

1. Daily function. What the person could do a year ago and what they can do now. A decline caused by the valve may reverse. A decline caused by something else usually will not. 2. Memory. Mild forgetfulness is common. Moderate or advanced dementia changes the likely benefit and the recovery plan. 3. Other illnesses. Kidney function, lung disease, previous stroke, cancer and nutrition. 4. Support at home. Someone needs to help with medicines, meals and follow-up visits for the first few weeks. 5. The patient’s own goals. Some want to walk to the temple again. Some mainly want to breathe comfortably at home. Both are reasonable, and they lead to different decisions.

The question the Heart Team is trying to answer is simple to state: will this procedure add good years, or only add a procedure? When the answer is unclear, a second opinion is a fair request.

What does recovery look like for a fit patient versus a frail one?

The two patients below are hypothetical examples, used only to show the difference.

A fit 84-year-old who walks daily and lives with family is often up and walking within a day. Most go home within a few days. Breathlessness usually improves over the following weeks as the heart works against a normal valve.

A frail 78-year-old with weight loss, low albumin and early memory problems may have a technically perfect procedure and still recover slowly. There is more risk of delirium in hospital, muscle loss and readmission. Some regain function with physiotherapy and nutrition support. Some do not.

Neither outcome is predictable from age. That is why the frailty assessment happens before the decision, not after. If the family is travelling from outside Rajasthan, our guide for outstation families explains how to plan the stay.

When is comfort care the right answer?

Sometimes the valve is severe but the person is near the end of life for other reasons. The 2021 ESC/EACTS guidelines advise against valve intervention in patients with severe other illnesses when it is unlikely to improve quality of life or extend survival beyond a year.

In practice, this includes advanced dementia, bed-bound patients whose immobility has another cause, and advanced cancer. Comfort care is not “doing nothing”. It means medicines to ease breathlessness and fluid build-up, managing pain, and planning care at home with the family.

Saying no to a procedure is a medical decision like any other, and it should be explained just as carefully as saying yes.

A World Heart Day message: do not call it “just old age”

The meta-analysis by Osnabrugge and colleagues pooled data on 9,723 people over 75. About 12.4% had some aortic stenosis and 3.4% had severe aortic stenosis. Among those with severe, symptomatic disease, 40.5% were not treated surgically.

A common story behind a late diagnosis is breathlessness or tiredness that the family put down to age. If a parent over 75 has become breathless on stairs, stopped walking as far, or fainted, ask for an echo. It is a painless test, and the answer changes what is possible.

You can read about others who went through this in our TAVI patient stories. To discuss a parent’s reports, arrange a TAVI consultation with Dr. Prem Ratan Degawat in Jaipur.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a TAVI consultation

FAQs

Is there an upper age limit for TAVI?

No fixed upper age limit exists in the guidelines. People in their late 80s and 90s have TAVI when the valve is the main cause of their symptoms. The decision depends on frailty, memory, other illnesses and the person’s goals. Age alone neither qualifies nor disqualifies someone for the procedure.

Is TAVI safer than open surgery for someone over 80?

For most people over 80 with severe aortic stenosis, TAVI avoids opening the chest and usually means a shorter recovery. It still carries risks, including stroke, bleeding, vascular injury and the need for a pacemaker. The Heart Team weighs these against the risks of surgery for each patient.

How is frailty checked before TAVI?

Frailty is measured rather than judged by appearance. Common checks include timed standing from a chair, walking speed, a brief memory test, blood tests for anaemia and albumin, recent weight loss and independence in daily tasks. Together they help predict how well someone will recover after the procedure.

Can medicines alone treat severe aortic stenosis in an elderly patient?

Medicines can ease breathlessness and fluid build-up, but they cannot open a narrowed valve. In the PARTNER trial, half of patients with severe aortic stenosis treated without valve replacement died within a year. When a procedure is not appropriate, medicines become part of comfort-focused care.

My father has mild memory problems. Can he still have TAVI?

Often, yes. Mild memory problems are common at this age and do not rule out TAVI. The team checks memory before the procedure because confusion after hospital stays is more likely. Moderate or advanced dementia changes the balance of benefit, so it needs an honest family discussion.

The post TAVI at 80, 85 and Beyond: Why Frailty Matters More Than the Number on the Birth Certificate appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Sep 18, 2026 · View LinkedIn profile

Valve-in-valve TAVI can treat a failing surgical tissue aortic valve by placing a new valve inside it, usually through an artery in the groin. It can avoid another open-heart operation in suitable patients. Whether it is right for you depends on why the old valve is failing, its internal size and the surrounding anatomy.

The old operation does not automatically rule you in or out. The first task is to identify exactly which valve you have.

What does it mean when a tissue valve wears out?

A tissue valve, also called a bioprosthetic valve, uses biological leaflets to control blood flow. Over time, those leaflets can become stiff with calcium or develop tears. A stiff valve may not open properly. A torn one may allow blood to leak backwards.

This deterioration is different from a blood clot on the valve or an infection called endocarditis. Leakage around the outside of a valve is another separate problem. The treatment may therefore be different even when two echo reports both say “prosthetic valve dysfunction.”

Prandi and colleagues’ review of valve-in-valve planning stresses identifying the cause before choosing a procedure. A new valve should not be the automatic response to every abnormal scan.

If the terminology is unfamiliar, our explanation of what TAVI involves covers the basic catheter procedure. Here, the extra challenge is fitting it safely inside an existing valve.

Which symptoms need a review?

You may notice breathlessness on a walk that used to be easy, or find that everyday activity leaves you unusually tired. Ankle swelling, chest discomfort or fainting can also need assessment. These symptoms have several possible causes, so they do not prove that the valve has failed.

Bring a change in symptoms to your cardiologist even if your routine echo appointment is months away. Comparing the current scan with earlier scans helps show what has changed.

Severe breathlessness at rest, ongoing chest pain or a collapse needs emergency medical assessment. Fever or chills in someone with a replacement heart valve also deserves prompt medical attention. Do not wait for a routine consultation when you are acutely unwell.

Who may be suitable for valve-in-valve TAVI?

The strongest reason to consider it is a significantly failing tissue aortic valve in someone for whom repeat surgery carries substantial risk. Previous chest surgery can make another operation more complex. Other illnesses and frailty also affect the balance.

But a difficult operation does not automatically make a catheter procedure safe. The new valve still needs room to open, and blood must continue to reach the coronary arteries that supply the heart muscle.

The Heart Team should compare both approaches. This includes an interventional cardiologist and a cardiac surgeon, with imaging specialists contributing to the plan. Our TAVI eligibility guide explains the general assessment; a previous tissue valve adds another layer of anatomical checks.

Surgery may be better if the original valve is too small, coronary obstruction cannot be prevented safely, or another heart problem also needs an operation. Active infection is a particular reason to consider a different treatment pathway. Younger patients need a longer view of future valve procedures as well.

What must the scans and old operation records show?

The label on your valve card is useful, but it is not enough by itself. Three questions deserve clear answers before consent.

How much room is actually inside the old valve?

The team needs the original valve’s model and size, then assesses its usable internal opening. The labelled size is not necessarily the space available for the new valve.

Putting a valve inside a small opening can leave a high pressure gradient, meaning the heart still has to push hard to move blood through it. If the effective opening is too small for your body’s needs, doctors call this prosthesis-patient mismatch. The old valve can be technically treated while the result remains less helpful than hoped.

Could the old leaflets block a coronary artery?

As the new valve expands, it pushes the old leaflets outwards. In some anatomies, these leaflets can obstruct a coronary opening. CT planning examines the coronary positions and the space around the old valve, including where a proposed new valve would sit.

Prandi and colleagues describe why this planning matters. A specialised protective technique may be possible in selected cases, but it does not remove every risk. Some patients are better served by surgery.

Will the result preserve future treatment options?

The team also considers access to the coronary arteries after implantation and what another valve procedure might involve later. This matters especially when life expectancy is long. “We can keep adding valves” is not a sound lifetime plan.

Kidney function and the arteries used to deliver the valve also need assessment. Tell the team about previous contrast reactions and bring existing scan images, not just written reports.

How does it compare with another open operation?

Valve-in-valve TAVI usually avoids reopening the chest and a new breastbone wound. Repeat surgery removes the old prosthesis and may allow the surgeon to address a small opening or other problems at the same operation. Each approach solves a different set of constraints.

A 2022 meta-analysis by Raschpichler and colleagues combined 15 nonrandomised studies involving 8,881 patients. Valve-in-valve was associated with lower short-term mortality and less acute kidney failure. However, severe prosthesis-patient mismatch was more frequent and the remaining pressure gradients were higher. Midterm mortality did not differ significantly.

These were not randomised comparisons. Differences between the patients selected for each treatment could affect the findings. They do not establish that TAVI is safer for every individual.

For broader recovery differences, see our comparison of TAVI and open-heart surgery. Your own decision needs the specific risks of a repeat operation and the CT findings together.

What happens during the procedure and recovery?

The replacement valve is carried on a catheter, most often through a groin artery. Imaging guides it into the old tissue valve, where it is expanded. The old surgical valve remains in place. The team then checks blood flow and looks for leakage or coronary problems.

Avoiding a chest incision does not make this a minor procedure. Risks include bleeding or artery damage, stroke, kidney injury and valve leakage. Some patients need a pacemaker. Coronary obstruction and death are also possible and belong in the consent discussion.

Afterwards, monitoring checks heart rhythm and the groin access site. An echo assesses the new valve. Discharge depends on recovery and any complications, rather than a promised number of nights. Our day-by-day TAVI admission guide explains the hospital routine, although a repeat-valve case may need a different stay.

Leave with a written medicine plan and follow-up dates. Blood-thinning treatment depends on your other conditions as well as the procedure. Do not start, stop or change it yourself. Ongoing valve surveillance and attention to dental health remain part of care.

What should you bring to a Jaipur consultation?

Bring the old operation note and valve card if available. Add your latest echo with images, earlier echo reports for comparison, and a current medicine list. Include records of any bypass operation or coronary stents.

Dr. Degawat’s second-opinion assessment includes an independent review of prior findings. For a failed tissue valve, the discussion should explain the cause of failure, the predicted result with each treatment and the reason for the recommendation.

Valve-in-valve TAVI offers another route for some families facing repeat surgery. The useful next step is an assessment of the existing valve, not a promise based on age or a single report. Arrange a TAVI consultation with Dr. Prem Ratan Degawat in Jaipur to review those options.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur. His work includes valve-in-valve and TAVR-in-TAVR procedures.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a valve consultation

FAQs

Can valve-in-valve TAVI treat a mechanical heart valve?

No. Standard aortic valve-in-valve TAVI is intended for a failing tissue valve, not a mechanical valve with rigid moving components. If you are unsure which type you have, check your valve card or operation record. A mechanical valve problem needs its own assessment and treatment plan.

Can it treat a leaking valve as well as a narrowed one?

It can treat selected surgical tissue valves that have narrowed, developed leakage through damaged leaflets, or both. Leakage around the outside of the prosthesis is a different problem. Echo and other imaging must identify the source of the leak before the team can recommend the appropriate treatment.

How long will the new valve last?

There is no guaranteed lifespan for an individual valve-in-valve implant. The original valve’s size and the final blood-flow result matter. Published results for first-time TAVI cannot simply be applied to every repeat procedure. Our valve durability guide gives background, while your team should explain the evidence relevant to your situation.

Can I have another TAVI after a previous TAVI?

Sometimes. This is often called redo TAVI or TAVR-in-TAVR. The existing transcatheter frame and the position of its leaflets make coronary access and obstruction separate planning concerns. Suitability must be checked with imaging; a previous successful TAVI does not guarantee that a second or third one will be feasible.

Is repeat surgery ruled out because I am older?

No. Age is one part of the decision, alongside frailty and other illnesses. A small old valve or unsafe coronary anatomy can make surgery the better choice even in an older person. Ask the Heart Team to explain both options using your scans and your goals for recovery.

The post Valve-in-Valve TAVI: When a Previous Tissue Valve Wears Out appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Sep 10, 2026 · View LinkedIn profile

अगर आपकी echo report में “severe aortic stenosis” लिखा है, तो इसका मतलब है कि heart का aortic valve इतना सिकुड़ चुका है कि उसे बदलने पर विचार शुरू कर देना चाहिए। Report में तीन आंकड़े यह तय करते हैं: mean gradient, aortic valve area और peak velocity। नीचे हर आंकड़े का मतलब, guideline में तय सीमा के साथ दिया गया है।

एक बात साफ़ रहनी चाहिए। Report सिर्फ़ बीमारी की गंभीरता बताती है, इलाज नहीं। इलाज का फ़ैसला आंकड़ों और मरीज़ के लक्षणों, दोनों को देखकर होता है।

ये सीमाएं 2020 ACC/AHA valvular heart disease guideline से ली गई हैं। European guideline में mild की सीमा थोड़ी अलग है, इसलिए अलग-अलग labs की report में किनारे पर हल्का अंतर दिख सकता है। बीच की दोनों श्रेणियों पर दोनों guidelines एकमत हैं।

Echo Report में क्या देखा जाता है

Echo ध्वनि तरंगों पर आधारित जांच है। इसमें न विकिरण होता है और न कोई चीरा लगता है।

यह जांच valve से गुजरने वाले खून की रफ़्तार नापती है। Valve जितना सिकुड़ता है, खून को उतने ही तंग रास्ते से निकलना पड़ता है और रफ़्तार बढ़ जाती है। इसी रफ़्तार के आधार पर report के बाकी आंकड़े निकाले जाते हैं।

इसलिए report में लिखा हर आंकड़ा आखिर में दो ही बातें बताता है। valve कितना कम खुल रहा है, और heart को उसमें से खून भेजने के लिए कितना ज़्यादा ज़ोर लगाना पड़ रहा है।

Report की चार लाइनें जो सबसे अहम हैं

Peak velocity (Vmax). खून की सबसे तेज़ रफ़्तार, m/s में। Valve जितना सिकुड़ेगा, यह उतना बढ़ेगा। 4.0 m/s इसकी severe सीमा है।

Mean gradient. Valve के दोनों तरफ़ दबाव का औसत अंतर, mmHg में। मेरे अनुभव में यह सबसे भरोसेमंद आंकड़ा है, क्योंकि यह पूरी धड़कन का औसत लेता है, सिर्फ़ एक ऊंचे पल का नहीं। 40 mmHg या उससे ऊपर severe माना जाता है।

Aortic valve area यानी valve के खुलने की जगह, cm² में। सामान्य valve 3 से 4 cm² तक खुलता है। 1.0 cm² पर इसे severe माना जाता है, यानी सामान्य का करीब एक-चौथाई।

LVEF यानी ejection fraction बताता है कि heart का पंप करने वाला हिस्सा हर धड़कन में कितना खून बाहर भेज रहा है। 50 से 70 प्रतिशत सामान्य माना जाता है।

जब आंकड़े आपस में मेल न खाएं

यही वह स्थिति है जिसमें सबसे ज़्यादा उलझन होती है, और इसका कोई एक सीधा जवाब नहीं है।

कई बार valve area तो severe सीमा में होता है, लेकिन mean gradient 40 mmHg से नीचे रहता है। दोनों एक साथ कैसे हो सकते हैं?

इसकी वजह यह है कि gradient तभी ऊंचा बनता है जब heart में इतनी ताकत बची हो कि वह खून को पूरे ज़ोर से आगे भेज सके। अगर पंप करने की ताकत कमज़ोर है, या heart का हिस्सा छोटा और सख़्त हो चुका है, तो हर धड़कन में कम खून निकलता है और दबाव का अंतर भी कम बनता है। Valve उतना ही सिकुड़ा रहता है, लेकिन gradient उस गंभीरता को दिखा नहीं पाता।

इसे low-flow low-gradient severe aortic stenosis कहते हैं। इसमें एक और आंकड़ा देखा जाता है, stroke volume index, और 35 mL/m² से कम होने पर बहाव कम माना जाता है। कमज़ोर पंपिंग वाले मामलों में अक्सर dobutamine stress echo करनी पड़ती है, ताकि असली गंभीरता सामने आ सके।

इलाज के लिहाज़ से यह स्थिति अहम है। अगर यहां गंभीरता कम आंकी जाए तो इलाज देर से शुरू होता है। मेरे पास ऐसे मरीज़ आए हैं जिन्हें सालों तक moderate मानकर दोबारा जांच पर टाला जाता रहा।

Report क्या नहीं बताती

Report यह नहीं बताती कि valve बदलवाना चाहिए या नहीं।

Guideline के मुताबिक यह फ़ैसला गंभीरता और लक्षण, दोनों को मिलाकर लिया जाता है। Severe stenosis के साथ अगर चलने पर सांस फूलती है, सीने में भारीपन रहता है, चक्कर आते हैं या बेहोशी हुई है, तो इलाज पर तुरंत विचार होना चाहिए। Severe होने पर भी अगर कोई लक्षण नहीं है, तो कई मरीज़ों को नियमित जांच पर रखा जाता है।

OPD में मैं एक सवाल ज़रूर पूछता हूं। कई बुज़ुर्ग मरीज़ कहते हैं कि उन्हें कोई तकलीफ़ नहीं है, जबकि असल में उन्होंने चलना-फिरना धीरे-धीरे कम कर दिया होता है। सीढ़ी चढ़ना छोड़ देना भी एक लक्षण है, भले ही वह report में कहीं दर्ज न हो। यह सवाल मैं अक्सर मरीज़ से नहीं, उनके परिजनों से पूछता हूं, क्योंकि जवाब ज़्यादा सही मिलता है।

Moderate aortic stenosis वाले मरीज़ों के लिए एक बात ध्यान देने लायक है। ACC/AHA guideline के मुताबिक moderate aortic stenosis आमतौर पर हर साल करीब 0.3 m/s रफ़्तार, 7 mmHg gradient और 0.1 cm² valve area की दर से बढ़ती है। यानी moderate कोई ठहरी हुई स्थिति नहीं, बल्कि आगे बढ़ने वाली बीमारी है। इसीलिए दोबारा जांच की तय तारीख टालनी नहीं चाहिए।

Cardiologist को कब दिखाएं

अगर report में severe लिखा है, तो valve का काम करने वाले cardiologist से एक बार सलाह ज़रूर ले लेनी चाहिए, चाहे लक्षण हों या न हों।

Moderate के साथ अगर लक्षण मौजूद हैं, तब भी दिखा लेना बेहतर है, क्योंकि तब यह तय करना होता है कि तकलीफ़ valve की वजह से है या किसी और कारण से।

और अगर आंकड़े आपस में मेल नहीं खा रहे, जैसा ऊपर बताया गया, तो यह अपने आप में दिखाने की पर्याप्त वजह है। ऐसे मामलों में गंभीरता तय करना ही सबसे बड़ा काम होता है।

Aortic stenosis के लक्षण और इलाज के विकल्प aortic stenosis के इस page पर विस्तार से दिए गए हैं। अगर valve बदलने पर बात चल रही है, तो TAVI क्या होता है पहले पढ़ लें, और TAVI के लिए सही उम्मीदवार कौन है वाला page भी देख लें।

Jaipur में echo कहां कराएं

Echo ज़्यादातर बड़े cardiology सेंटरों में हो जाती है। Valve की बीमारी में फ़र्क़ मशीन से कम और नाप करने वाले के अनुभव से ज़्यादा पड़ता है, खासकर low-flow वाले मामलों में, जहां नापने का तरीका ही नतीजा बदल देता है।

कौन सी जांच कब और क्यों की जाती है, यह valve के इलाज से पहले होने वाली जांचों वाले page पर दिया गया है। वह page बताता है कि जांचें कैसे होती हैं, और यह page बताता है कि उनके आंकड़ों का मतलब क्या है।

Valve की जांच और इलाज Eternal Hospital, Jaipur में हमारे TAVI और structural heart programme के तहत किया जाता है। बाहर से आने वाले मरीज़ अपनी report पहले भेज दें, ताकि पहली मुलाकात ज़्यादा काम की रहे।

दिखाने आते समय पूरी report साथ लाएं, सिर्फ़ आखिरी summary लाइन नहीं। पुरानी echo भी रखें। दो reports के बीच का अंतर अक्सर किसी एक आंकड़े से ज़्यादा बताता है।

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur
• Contact: +91-8960594076

Book an appointment today

अक्सर पूछे जाने वाले सवाल

Mean gradient 45 mmHg का मतलब क्या है?

2020 ACC/AHA guideline के मुताबिक 40 mmHg या उससे ऊपर severe aortic stenosis माना जाता है, इसलिए 45 severe सीमा में आता है। इसका मतलब है कि valve बदलने पर विचार शुरू होना चाहिए। आगे का फ़ैसला आपके लक्षणों और बाकी आंकड़ों पर निर्भर करेगा।

Valve area 0.8 cm² है, क्या यह चिंता की बात है?

1.0 cm² या उससे कम severe माना जाता है, इसलिए 0.8 severe सीमा में है। यह ऐसी स्थिति नहीं कि उसी दिन भागना पड़े, लेकिन इसे टालना ठीक नहीं। valve का काम करने वाले cardiologist से एक बार सलाह ले लें।

क्या severe होने पर तुरंत ऑपरेशन ज़रूरी है?

हमेशा नहीं। अगर गंभीरता के साथ लक्षण भी हैं, तो इलाज जल्दी होना चाहिए। बिना लक्षण वाले कई मरीज़ों को नियमित जांच पर रखा जाता है। यह फ़ैसला cardiologist ही करेंगे।

LVEF कम है, क्या इसका मतलब valve ठीक नहीं होगा?

नहीं। पंप करने की ताकत का कमज़ोर होना अक्सर valve पर पड़े बोझ का ही नतीजा होता है, और valve बदलने के बाद कई मरीज़ों में LVEF सुधर जाती है। कम LVEF इलाज रोकने की वजह नहीं है।

Echo दोबारा कितने समय बाद करानी चाहिए?

यह गंभीरता पर निर्भर करता है। Severe में आमतौर पर छह महीने से एक साल के बीच, moderate में करीब हर साल, और mild में उससे कम बार। सही समय आपके cardiologist तय करेंगे।

Report में “sclerosis” लिखा है, क्या यह stenosis ही है?

नहीं। Aortic sclerosis का मतलब है कि valve मोटा हो चुका है, लेकिन खून के बहाव में रुकावट अभी नहीं आई। यह stenosis से पहले की स्थिति है। इस पर इलाज नहीं, नज़र रखी जाती है।

Sclerosis कितनी बार stenosis में बदलता है और इस दौरान क्या करना चाहिए, यह हमारे लेख Aortic Valve Sclerosis vs Aortic Stenosis (अंग्रेज़ी में) में विस्तार से बताया गया है।

The post Echo Report कैसे पढ़ें: Aortic Stenosis की Grading, Gradient और Valve Area का मतलब appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Sep 5, 2026 · View LinkedIn profile

If you have been told your aortic valve is bicuspid and that this complicates a TAVI, the short answer is that it complicates the planning, not the possibility. Most bicuspid patients who need their valve replaced can have it done through the leg, without opening the chest. The anatomy changes how carefully the valve has to be sized and chosen, and in some patients it still tips the decision toward surgery.

Here is the honest summary before the detail.

What a bicuspid aortic valve actually is

Your aortic valve is the door between the heart and the body. It normally has three leaflets that open and shut with every beat. About one person in every fifty to two hundred is born with only two, which is what bicuspid means. It is the most common condition anyone is born with in the heart, and most people who have it never find out until a scan or a murmur brings it up.

Two leaflets do the same job. They just do it under more strain.

Why a bicuspid valve narrows earlier

A two-leaflet valve opens in a slightly oval shape rather than a clean triangle. The leaflets flex against each other in a way three leaflets do not. Over decades that extra mechanical stress speeds up calcium deposits on the valve.

The practical effect is age. Aortic stenosis in a person with three leaflets usually becomes a problem in the late seventies or eighties. In a bicuspid valve it often arrives ten to twenty years sooner. That is why I see bicuspid patients in their fifties and sixties with severe stenosis, sitting in the clinic looking otherwise fit and healthy, and completely thrown by the diagnosis.

Many of them also have some widening of the aorta just above the valve. That is part of the same condition and it has to be measured, because it sometimes changes the whole plan.

Why bicuspid anatomy used to rule out TAVI

Early TAVI valves were designed around a round opening with three leaflets. Bicuspid anatomy is not round. It is more elliptical, the calcium sits in heavier and more uneven ridges, and there is often a raphe, which is a fused seam where two leaflets joined during development.

That combination caused three problems in the early years. Valves did not always expand evenly. Leaks around the edge of the new valve were more common. And a stiff, heavily calcified ring carried a risk of tearing when the valve was expanded into it.

Those were real concerns, and bicuspid patients were excluded from the trials that first proved TAVI works. Being excluded from a trial is not the same as being harmed by a treatment, but it left a gap in the evidence that took years to fill.

Three things changed. Imaging got better, so the anatomy can now be measured precisely before anyone touches the patient. Newer valve designs seal better against an irregular ring. And operators built up enough bicuspid volume to learn how these cases behave.

What the evidence actually shows now

This is where I want to be careful, because the honest answer has two halves and most pages only give you the first one.

The reassuring half comes from the STS/ACC TVT Registry analysis published by Makkar and colleagues in JAMA in 2021. It matched 3,168 pairs of low surgical risk patients, bicuspid against three-leaflet, all treated with the same balloon-expandable valve. Death at 30 days was 0.9% in the bicuspid group and 0.8% in the other. There was no significant difference in death or stroke at 30 days or at one year, and no difference in how well the valves worked afterwards.

The cautionary half comes from NOTION-2, which randomly assigned 370 younger low-risk patients to TAVI or surgery and followed them for three years. Across the whole trial the results were close. In the patients with three leaflets they were almost identical, 14.5% against 14.4% for the combined outcome of death, stroke or hospitalisation. But in the bicuspid patients the numbers separated: 20.4% after TAVI against 7.8% after surgery. The confidence interval was wide and the difference did not reach statistical significance, so this is a signal rather than a verdict. It is still a signal I take seriously in a 62-year-old.

So the fair summary is that bicuspid anatomy is not a barrier in older patients with suitable anatomy, and remains a genuine open question in younger ones.

How I plan a bicuspid case

A bicuspid TAVI is won or lost on the CT scan, not in the cath lab. Before I commit, I want four things settled.

I measure the annulus and the level just above it separately. In a three-leaflet valve, sizing off the annulus alone is usually enough. In bicuspid anatomy the narrowest point is often higher, at the level of the fused raphe, and a valve sized only to the annulus can sit too large for the space it actually has to open into.

I map where the calcium sits. Heavy calcium on the raphe, especially in a continuous bar, is the pattern most associated with uneven expansion and leaks. When I see it, I size down rather than up.

I measure the aorta above the valve. If it is dilated beyond the point where it needs treating in its own right, then the valve is no longer the whole problem, and an operation that deals with both may serve the patient better than a procedure that deals with one.

I check the height of the coronary arteries. Bicuspid leaflets are often long, and a displaced leaflet can sit across a coronary opening.

Only when those four line up do I talk to the patient about a date. If they do not, I say so, and I explain why. You can read how this fits the wider assessment on our page on who qualifies for TAVI.

When I still recommend open surgery

There are bicuspid patients I do not offer TAVI to, and I would rather say that plainly than pretend the procedure suits everyone.

If you are in your fifties or early sixties and fit for an operation, I will usually put surgery on the table as the first option, and the NOTION-2 bicuspid numbers are the reason. If the aorta above the valve is significantly enlarged, surgery treats both problems in one sitting. If the anatomy is heavily and asymmetrically calcified in a way that suggests the valve will not seat evenly, the catheter route stops being the gentler route. And if the coronary heights are unfavourable, the risk is not worth it.

None of that is a failure of TAVI. It is the reason a heart team exists.

Recovery and what happens afterwards

For a bicuspid patient who is suitable, recovery looks like any other TAVI. Most people are up the next day and home within two to four days, with no chest wound and no sternum to heal.

The durability question matters more here, because bicuspid patients are younger and will live with the valve longer. In NOTION-2 at three years, moderate or worse deterioration of the valve was 4.5% after TAVI and 5.2% after surgery, so the early durability data are reassuring. Three years is still short for a 60-year-old, and I say that openly. We cover this in more detail on how long a TAVI valve lasts.

Which valve gets used is part of the same conversation, and the trade-offs are set out on our page comparing balloon-expandable and self-expanding valves.

Where to start if this is you

Bring your echo report and, if you have one, your CT angiogram. If you do not have a CT yet, that is the scan that will answer most of the questions above. If you are new to the procedure itself, start with what TAVI involves.

Assessment and treatment for bicuspid aortic stenosis are done at Eternal Hospital, Jaipur, as part of our TAVI and structural heart programme. If you are travelling from outside Rajasthan, send your reports ahead so the first visit is useful.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur
• Contact: +91-8960594076

Book an appointment today

FAQs:

Is TAVI safe if I have a bicuspid aortic valve?

In low surgical risk patients, the 2021 JAMA registry analysis by Makkar and colleagues found 30-day death of 0.9% in bicuspid patients against 0.8% in three-leaflet patients, with no significant difference at one year. Safety depends far more on your specific anatomy than on the number of leaflets.

Am I too young for TAVI if my bicuspid valve is failing at 55?

You are not too young for the procedure, but age changes the balance. In the NOTION-2 trial, younger bicuspid patients did better with surgery over three years. For a fit patient in their fifties, I usually recommend discussing surgery first.

Why was my bicuspid valve only found now?

Most bicuspid valves cause no symptoms for decades. They are commonly found when a murmur is heard, or when an echocardiogram is done for something else. Finding it later is normal and does not mean anything was missed.

Does a bicuspid valve mean my children should be checked?

It runs in families more often than a three-leaflet valve does, so first-degree relatives are usually offered a screening echocardiogram. It is a simple, painless scan.

Will I need my aorta treated as well?

Sometimes. Widening of the aorta above the valve is part of the same condition. If it is large enough to need treatment in its own right, that changes the plan and often favours surgery, because both can be dealt with together.

Can a bicuspid valve be repaired instead of replaced?

Repair is possible in selected younger patients, mostly when the valve is leaking rather than narrowed. Once a valve is heavily calcified and narrowed, replacement is the realistic option.

The post TAVI for a Bicuspid Aortic Valve: What It Means, and Why It Is Not a Reason to Panic appeared first on Dr Prem Ratan Degawat.

Many congenital heart defects can now be closed with a small implant passed through a vein in the leg, with no chest incision and no heart-lung machine. The procedure is called device closure. Most patients walk the next morning and go home within a day or two.

That is the short answer. The longer answer is that not every defect qualifies, and deciding who qualifies is most of the work.

What device closure actually involves

You lie on the cath lab table awake, with sedation and local anaesthesia at the groin. There is no general anaesthesia in most adult cases.

A thin tube goes into the femoral vein at the top of the leg. Under X-ray and echocardiography guidance, that tube is advanced to the heart and across the defect. The device, which is a small mesh implant shaped like two discs joined at the waist, is pushed through the tube and opened on both sides of the opening. The discs sit against the walls and sandwich the defect shut.

Nothing is stitched. Over the following months your own tissue grows over the mesh and it becomes part of the wall.

The whole thing usually takes under an hour. You are awake for it, and you will hear the team talking.

Which defects can be closed with a device and which cannot

This is the part patients most want a straight answer on, so here it is.

ASD. Only the secundum type is suitable. That is the most common variety, sitting in the middle of the wall between the atria. It works because the defect has a border of tissue all around it, called a rim, that the device can grip. Primum and sinus venosus defects sit at the edge of the septum with no usable rim on one side. Those still need surgical repair, and I say so plainly when the echo shows it.

PDA. Most are closable with a duct occluder or a coil. The vessel is a tube, and a plug sits in it well.

VSD. The most selective of the three. Muscular defects in the middle of the septum are the friendliest. Perimembranous defects sit close to the heart’s electrical conduction system, and pressure from a device there can cause heart block that needs a permanent pacemaker. That risk is the reason VSD device closure is offered to fewer patients than ASD closure, and it is the risk I spend the most time explaining.

The 2020 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease recommends closing a secundum ASD when there is right heart enlargement and evidence of a significant shunt, even in patients who feel well. That last part matters, because plenty of adults with a sizeable ASD say they feel fine.

How the decision actually gets made

A defect on a report is not by itself a reason to close anything. Before I commit to a device I want four things answered.

First, is the right side of the heart enlarged. A defect that has been shunting blood for years stretches the right atrium and right ventricle. That enlargement, more than the size of the hole, is what tells me the heart is carrying a load it should not.

Second, what do the rims look like. This needs a transoesophageal echo, where the probe goes down the food pipe and sits directly behind the heart. Surface echo is not enough to size an ASD properly. I have sent patients for a TOE after a normal-looking surface study and found the rim was too thin to hold a device.

Third, what are the lung pressures. If pulmonary pressure has already climbed too high, closing the defect can make a patient worse rather than better. This is the single most important reason not to rush.

Fourth, is there anything else going on. Adults sometimes arrive with an ASD and atrial fibrillation together, or with valve disease alongside. The plan has to account for all of it.

If you want to understand the tests themselves, we have written them up in plain language in our guide to heart tests in Jaipur.

The day of the procedure

You come in the day before or the same morning, depending on the case. Blood work is reviewed. You stop eating from midnight.

In the lab, the groin is numbed. Access is taken, the defect is crossed, and the size is measured. Then the device is opened and, before anything is released, we check the position from several angles and confirm there is no leak around the edges and nothing is pressing on a nearby valve. Only then does the device come off its cable.

You lie flat for a few hours afterwards so the groin site seals. Most patients eat dinner the same evening.

Afterwards

You will be on a blood thinner for a period, usually aspirin, while the surface of the device heals over. The exact duration depends on the device and the defect, and I set it case by case.

You will need an echo before discharge, and again at intervals over the first year. Antibiotic cover before dental work matters for the first six months after implantation.

Most people return to desk work within a week. Heavy lifting waits longer.

What surprises adults most is how much better they feel. Someone who has spent years assuming they were simply unfit often notices within weeks that stairs stopped being an event.

When I do not close a defect

Being honest about this is more useful than a list of successes.

I do not close a small defect that is causing no chamber enlargement and no symptoms. It does not earn the implant.

I do not close when pulmonary pressures are too high, because the defect may be acting as a relief valve at that stage.

I do not close a defect with an inadequate rim just because the family would prefer to avoid surgery. A device that embolises is a far worse day than a planned operation.

And I do not close a perimembranous VSD without a long conversation about the pacemaker risk first.

Device closure sits in the same family of work as the other structural procedures we do in Jaipur, including left atrial appendage closure and paravalvular leak closure, and the same principle applies across all of them. The catheter route is a better route only when the anatomy suits it.

If you are weighing an operation you have already been offered, a second opinion before heart surgery is a reasonable thing to ask for, and no cardiologist should mind you asking.

Where this is done in Jaipur

These procedures are performed at Eternal Hospital, Jaipur, in the same cath lab used for our TAVI and structural heart work. Bring your echo report and any previous records to the first visit. If you are travelling from outside Rajasthan, send the reports ahead so the visit is useful rather than exploratory.

You can read more about the practice on our page for interventional cardiology in Jaipur.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur
• Contact: +91-8960594076

Book an appointment today

FAQs:

Is device closure safer than open heart surgery?

For the right anatomy, it avoids a chest incision, the heart-lung machine and a long recovery. That is a real advantage. But safety depends on suitability, not on the route itself. A defect that is wrong for a device is safer treated surgically.

How long does the device stay in the heart?

Permanently. Within a few months your own tissue grows over the mesh and covers it. It is not removed and does not need replacing.

Will I need a pacemaker afterwards?

For ASD and PDA closure this is uncommon. The concern is mainly with perimembranous VSD closure, where the device sits near the conduction system. I discuss that risk in detail before offering it.

Can an adult have an ASD closed, or is it only for children?

Adults are closed regularly, and many are diagnosed only in adulthood. The 2020 AHA/ACC congenital heart disease guideline supports closing a secundum ASD in adults with right heart enlargement and a significant shunt.

What tests do I need before the procedure?

An ECG and a surface echocardiogram to start. A transoesophageal echo is usually needed to size the defect and assess the rims properly. Some patients also need an assessment of lung pressures.

How soon can I go back to work?

Most people doing desk work return within about a week. Heavy physical work and gym training wait longer, and I set that individually.

Does a small hole always need closing?

No. A small defect causing no chamber enlargement and no symptoms is often watched rather than closed. Treatment should follow the load on the heart, not the presence of a finding on a report.

The post ASD, VSD and PDA Device Closure in Jaipur: Treatment Without Open Heart Surgery appeared first on Dr Prem Ratan Degawat.

If you are reading this from Rohtak or Ludhiana or south Delhi, you have probably already been told your parent needs an aortic valve replaced, and someone has suggested Jaipur. The practical questions come next. How long will we be away from home. What do we send before we travel. Where does the attendant sleep. What does the whole thing cost once travel is counted. And the question nobody asks out loud: is this trip even a good idea.

This page answers those in order. It is written for families coming to Eternal Hospital in Jagatpura, Jaipur, Rajasthan, from outside the state, and it includes an honest section on when you should stay home and have the procedure done locally instead.

Why families travel to Jaipur for a heart valve at all

Three reasons come up again and again in our outpatient department.

The first is volume. Structural heart work is a procedure where practice shows in the results, and the 2020 ACC/AHA valve guideline explicitly recommends that these interventions happen at centres that do enough of them and report their outcomes. Dr. Degawat has done over 600 TAVI procedures, including bicuspid valves, valve-in-valve cases and TAVR inside a previous TAVR. Those are the cases that get turned away elsewhere.

The second is the Heart Team. The same guideline asks for a joint decision between an interventional cardiologist, a cardiac surgeon and an imaging specialist rather than one doctor deciding alone. That structure exists at Eternal and it is why some patients who arrive expecting TAVI leave with a recommendation for surgery, or for waiting.

The third is cost. A TAVI in Jaipur generally lands below what the same valve and the same procedure cost in a Delhi or Mumbai corporate hospital. For a family paying out of pocket, the difference is usually larger than the entire travel budget.

Send the reports before you send the patient

This is the single most useful thing in this article, so it goes early.

Do not put an eighty-year-old in a car for six hours to find out whether the procedure is even possible. Send the reports first and get an opinion on them. Almost every case we accept from outside Rajasthan starts that way.

What to send, as clear photographs or PDFs:

• The echocardiogram report, with the images on a CD or drive if you have them
• The CT angiogram if one has been done, images included, not just the printed summary
• Any coronary angiography report
• Recent blood work, including kidney function
• The ECG
• A list of current medicines, photographed as the actual strips
• A one-page summary of what other doctors have already advised, and what they said no to

The images matter more than the reports. A radiologist’s summary tells us the valve is severely narrowed. The actual CT images tell us the annulus measurement, the calcium pattern and whether the femoral arteries will take the delivery system, which is what decides whether the trip is worth making. Our page on getting a second opinion on heart surgery covers what a good second opinion should give you back.

You should get one of three answers: come for assessment, this needs surgery rather than TAVI, or this can be managed where you are.

What the first visit covers

Assume the first trip is an outpatient visit, not an admission. OPD runs Monday to Saturday, 10:00 AM to 4:00 PM.

The consultation reviews everything you sent, examines the patient, and usually repeats the echocardiogram on our own machine, because measurement technique varies between labs and the numbers drive the valve choice. If the CT angiogram has not been done, or was done without the protocol we need, it gets done here. That is normally the same visit or the next morning.

You leave that visit knowing whether TAVI is being offered, which valve, roughly what it will cost, and when a slot is available.

How long to plan for

For most outstation families the honest answer is seven to ten days in Jaipur, and it splits like this.

One to two days for the consultation and any repeat imaging. A gap of a few days while the Heart Team reviews and the slot is confirmed, though this can be compressed if you have travelled far. Then three to four days for the admission itself, which is the standard TAVI stay. The PARTNER 3 trial reported a median hospital stay of three days after TAVI, and our numbers sit in the same band. Then a day or two before travelling home, because we like to see the patient once after discharge before a long road journey.

Some families split it into two trips instead: come for the assessment, go home, come back for the procedure. That works well if you are within a day’s drive, from Delhi or Haryana say. It works badly from Surat, where the travel itself is the tiring part and doing it twice costs more than the extra hotel nights.

We have set out exactly what those admission days involve in our day by day guide to a TAVI admission in Jaipur.

Where attendants stay near Jagatpura

The hospital is in Jagatpura, on the Jagatpura Road near Jawahar Circle, which is the south-eastern side of Jaipur and about 20 to 25 minutes from the airport.

One attendant stays in the patient’s room overnight. Everyone else needs a bed outside. There is a range of guest houses, service apartments and hotels within a short auto ride of the hospital, across a wide price range, and the hospital’s front desk keeps a list. Book for a longer stay than you think you need and extend rather than shorten, because moving hotels mid-admission with an exhausted family is miserable.

Practical points families tell us afterwards they wish they had known: keep one person free of hospital duty to handle billing and paperwork, carry cash for small things even though the hospital takes cards, and expect Jaipur to be considerably hotter than Punjab from April to September.

What to budget beyond the procedure

TAVI itself runs in the ₹15 to ₹30 lakh band at private centres in India, and the valve is most of that figure. On top of it, an outstation family should budget for travel for two to four people, seven to ten nights of accommodation for the attendants, local transport, food, and the pre-procedure imaging if it is repeated here.

That travel and stay total is real money, but it is normally a small fraction of the valve cost, and it is often less than the price difference between Jaipur and a metro corporate hospital. Work out both totals before deciding on geography alone.

If you are covered by a scheme or a private policy, start the paperwork before you travel, not after you arrive. Pre-authorisation takes time and it is far easier to chase from home.

When you should not travel

No competitor page in this space has this section, and it is the most important one here.

Do not travel if the patient is in decompensated heart failure right now, breathless at rest or unable to lie flat. That patient needs stabilising at the nearest hospital first. A six-hour car journey in that state is dangerous and we will not accept the case until it is controlled.

Do not travel on the strength of an echo alone if the patient is frail enough that the journey itself is a risk. Send the reports, and let us tell you whether it is worth it.

Do not travel if a competent centre near you already offers the same procedure and the same valve, and the Heart Team there has agreed the plan. Distance adds nothing on its own. There is no benefit to a Jaipur postcode if the case is straightforward and the local team does enough of them.

And do not travel if the real problem is that you did not like the answer you were given. If three cardiologists have advised surgery rather than TAVI, a fourth opinion is unlikely to change the anatomy. Get the reasoning explained properly instead.

Where travel does make sense is the opposite situation: a patient turned down as too high-risk for open surgery, a complex valve, a previous valve that has failed, or a case where nobody nearby offers the procedure. Several of those stories are collected in our TAVI patient stories from north India.

Coming from your state

If you want the detail specific to where you are travelling from, we keep separate pages for TAVI and TAVR patients from Delhi, from Haryana, from Punjab and from Surat and Gujarat. The practice details and consultation options are on our TAVI and TAVR page for Jaipur and Rajasthan.

To start with a report review rather than a journey, send the documents on +91-8960594076 and ask for an opinion before you book anything.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Contact: +91-8960594076

Book an appointment today

FAQs:

Can I get an opinion before travelling to Jaipur?

Yes, and you should. Send the echocardiogram, CT angiogram images, angiography report, recent bloods, ECG and a medicine list on WhatsApp to +91-8960594076. You will be told whether to come for assessment, whether surgery suits better, or whether this can be managed near you.

How many days should an outstation family plan for in Jaipur?

Seven to ten days covers most cases. That is one to two days for consultation and imaging, a short wait for the Heart Team review and slot, three to four days for the admission itself, and a day or two after discharge before a long journey home.

Where do attendants stay during a TAVI admission?

One attendant stays in the patient’s room overnight. Others use guest houses, service apartments or hotels near Jagatpura, a short auto ride from the hospital, across a wide price range. The front desk keeps a list. Book longer than you expect and extend rather than move hotels mid-admission.

Is TAVI cheaper in Jaipur than in Delhi or Mumbai?

Usually yes. TAVI runs about ₹15 to ₹30 lakh at private centres in India, and Jaipur generally sits below metro corporate hospital pricing for the same valve. For most outstation families the saving is larger than the entire travel and accommodation budget, though you should compare both totals.

When should we not travel for TAVI?

Do not travel if the patient is breathless at rest or in decompensated heart failure, as that needs stabilising locally first. Do not travel if a nearby centre already offers the same procedure with an agreed Heart Team plan. Distance adds nothing on its own.

Do we need to repeat tests done in our home city?

Often the echocardiogram is repeated here, because measurement technique varies between labs and the numbers decide the valve size. A CT angiogram is repeated only if it was not done to the protocol needed for annulus measurement. Bring images, not just printed reports.

Can the whole thing be done in one trip?

Yes, and most outstation families prefer that. Splitting into an assessment trip and a procedure trip works well within a day’s drive, from Delhi or Haryana. From Gujarat, the second journey usually costs more in money and fatigue than the extra nights in Jaipur.

What should we arrange before leaving home?

Start insurance or scheme pre-authorisation before travelling, since it is easier to chase from home. Collect all reports and imaging discs in one folder. Photograph the actual medicine strips. Decide who handles billing, and keep that person off overnight hospital duty.

The post Coming to Jaipur for TAVI: A Guide for Families from Haryana, Punjab, Delhi and Gujarat appeared first on Dr Prem Ratan Degawat.

Almost every family that comes to us for TAVI in Jaipur asks the same thing first. Not “will it work”. They ask how many days they will be in hospital. The short answer is three to four days for a case that runs as planned, and the valve itself takes about an hour of that. Everything else is checking, watching and getting you back on your feet. Below is what those days actually look like at Eternal Hospital in Jagatpura, Jaipur, Rajasthan, in the order they happen.

If you are still deciding whether TAVI is the right operation for you at all, start with our guide on who qualifies for TAVI and who does not. This page assumes that decision has been made and answers the next question: what am I walking into.

How long does a TAVI hospital stay in Jaipur actually take?

That three to four day figure is not a local claim. In the PARTNER 3 trial, published in the New England Journal of Medicine in 2019, the median hospital stay was three days after TAVI compared with seven days after open surgery. Our Jaipur numbers sit in the same band, and that gap is the entire practical argument for the transcatheter route. If you want the fuller comparison, we have written it up in TAVI versus open heart surgery.

The week before admission, and the tests that decide everything

Nothing about the admission is decided on the day. It is decided in the workup, roughly seven to ten days earlier, and most of it is done as outpatient visits so you sleep at home.

The one test that matters more than the rest is the CT angiogram. It measures the aortic valve annulus to the millimetre, maps the calcium, and shows whether the femoral arteries in your groin are wide enough and clean enough to pass the valve through. That single scan decides which valve size you get and which route we take. If the groin arteries are too narrow or too calcified, we plan a different access point before you are ever admitted, not on the table.

Alongside it you will have an echocardiogram to grade the stenosis and check the other valves, a coronary angiography to see whether any blockage needs treating first, an ECG, a chest X-ray and a blood panel. We have set all of these out in detail on our page about the tests done before heart valve treatment in Jaipur.

One item surprises people every time: the dental check. The 2020 ACC/AHA valve guideline advises a dental evaluation before valve intervention, because bacteria from an infected tooth can settle on a new valve. I have postponed cases over an untreated abscess and I would do it again. A week’s delay is cheaper than valve endocarditis.

The day before, when you are admitted

You come in the afternoon before. A bed is allotted, the blood work is repeated or reviewed, and the anaesthesia team sees you. That conversation is worth paying attention to, because most TAVI cases here are done under local anaesthesia with sedation rather than general anaesthesia. You will be drowsy and comfortable but not fully unconscious, and you will hear us talking.

Consent happens the same evening. I go through it myself with the patient and at least one family member in the room. We cover what the valve is, the chance of needing a permanent pacemaker afterwards, the risk of bleeding at the groin, and the small stroke risk. I would rather have that conversation twice than have a family hear the word “pacemaker” for the first time on day two.

The groin is cleaned and shaved. You stop eating and drinking from midnight. Your regular medicines get sorted into what continues and what pauses, and blood thinners are the ones that usually change, so bring the actual strips rather than a list written from memory.

Procedure day, hour by hour

You go to the cath lab in the morning, usually first or second on the list. From there the sequence is fixed.

A local anaesthetic goes into the groin. A thin sheath is passed into the femoral artery, and a wire is threaded up to the heart under X-ray guidance. In most cases a balloon opens the old narrowed valve first. The new valve, crimped onto a stent frame, is then delivered on a catheter, positioned inside the old one and deployed. It starts working the moment it opens. We check the position and the leak with imaging before anything comes out, then remove the catheter and seal the puncture.

No chest is opened. No bone is cut. The heart is not stopped and no bypass machine is used. Total time in the room is usually 60 to 120 minutes, and the valve part of it is a few minutes at the end of a lot of careful positioning.

What your family is doing while you are in the cath lab

This is the part nobody writes about, and it is the part families remember.

They wait outside the lab. Someone from the team comes out with an update, usually within about 90 minutes of you going in. That update tells them the valve is in and how you are doing. They will not be allowed into the lab, and phones will not reach you.

My advice to families is practical. Send only two people to wait and let the rest go home, because the corridor is long and the day is longer. Carry the file. Eat something. If the wait runs past the estimate it is far more often because the list ran late than because something went wrong.

The first night after the new valve starts working

You are moved to a monitored bed within a few hours, usually a step-down or high-dependency bed rather than a full intensive care unit. That surprises families who were braced for ICU.

The single thing we watch hardest overnight is the heart rhythm. The new valve sits right next to the heart’s electrical conduction system, and pressure on it can slow the heartbeat enough to need a permanent pacemaker. In PARTNER 3 that happened in 6.6% of patients within 30 days. In the Evolut Low Risk trial, also published in the New England Journal of Medicine in 2019, it was 17.4%, and the difference reflects valve design as much as anything else. It is a real number and you deserve to hear it before, not after.

We also watch the groin site for bleeding, your blood pressure, and your urine output. You will be asked to keep the leg straight for a few hours. You can drink water.

Many patients tell us that night that the breathlessness has already gone. That is not imagination. The obstruction that made every stair a negotiation is gone the moment the valve opens.

The first full day, when you stand up again

The morning after, we get you sitting, then standing, then walking. Physiotherapy helps with the first few steps. Meals go back to normal.

I do not discharge a patient who has not walked the corridor unaided. It sounds basic, but walking tests the groin site, the blood pressure and the rhythm all at once, and it tells me more than another blood test would.

An ECG is repeated. Bloods are checked. The groin puncture is inspected for swelling or a lump.

What has to be true before the team lets you go home

Discharge is not a date on a calendar. It is a list, and all of it has to be true:

• The heart rhythm has stayed stable, with no new conduction block that needs a pacemaker
• The groin site is dry, soft and not swelling
• The echocardiogram shows the valve opening properly with no significant leak around it
• Blood pressure and haemoglobin are steady
• You have walked unaided and managed stairs if you have them at home
• Kidney function has not dropped after the contrast dye
• You and your attendant can both repeat the medicine schedule back to us

For most patients that list is complete one to two days after the valve, which puts the whole stay at three to four days.

What makes a stay run longer than four days

Being honest about this matters more than a tidy timeline.

The commonest reason is the rhythm. If the ECG shows a new conduction problem, we watch for another day or two, and a small number of patients need a permanent pacemaker before they leave. The second reason is the groin: a bleed or a swelling under the skin needs pressure, time and sometimes a scan. The third is kidney function dipping after the contrast, which usually recovers with fluids and patience. Older patients living alone, or those who came in already frail, sometimes stay an extra day simply because going home is not yet safe.

None of these mean the valve has failed. They mean the recovery needs more supervision than a corridor walk can provide.

What to bring, and who can stay with you

Bring all previous reports in one folder, in date order, oldest at the back. Bring the actual medicine strips. Bring loose clothing that opens at the front, non-slip slippers, a shawl because the ward runs cold, spectacles, hearing aids, and a phone charger with a long cable.

Leave jewellery at home. Leave large amounts of cash at home.

One attendant stays with you overnight. Plan for a second person during the day to handle billing and paperwork, because the two jobs pull in opposite directions and one tired relative cannot do both for four days. Families travelling in from outside Rajasthan should plan on roughly a week in Jaipur once travel and the pre-admission visits are counted.

What the hospital days add to the bill

The valve is the large number, not the room. TAVI in India runs about ₹15 to ₹30 lakh at private centres, and the valve itself accounts for most of that. The bed, the monitoring and the tests across three to four days are a much smaller share, which is why an extra day of observation moves the total far less than families fear. We have broken the components down on our TAVI cost page, including what insurance and the state schemes actually approve.

The follow-up calendar after you leave

You go home with a discharge summary, a card listing the new medicines, and a wound-check appointment about seven days out. After that the schedule is an echocardiogram and review at one month, again at six months in most cases, and then once a year for as long as you have the valve. The 2020 ACC/AHA valve guideline recommends this kind of periodic echocardiographic follow-up after any valve replacement, and it is how we pick up a problem while it is still small.

What you do in the first weeks at home matters as much as anything we did in the lab. Our Hindi guide on TAVI ke baad ghar par kya karein covers wound care, the blood thinners, the red flags and the diet in the register most of our Rajasthani families prefer. On the longer horizon, how long these valves last sets out what the registry data shows at five and ten years.

If you are weighing up where to have the procedure done, or want a second look at reports from another hospital, our TAVI and TAVR practice page for Jaipur and Rajasthan has the consultation details.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Contact: +91-8960594076

Book an appointment today

FAQs:

How many days do I stay in hospital for TAVI in Jaipur?

Three to four days in total for a straightforward case. You are admitted the day before, the valve goes in the next morning, and discharge follows one to two days later once the rhythm, the groin site and the echo are all satisfactory. The PARTNER 3 trial reported a median stay of three days.

Will I be unconscious during TAVI?

Usually not. Most TAVI procedures here are done under local anaesthesia at the groin with sedation, so you are drowsy and comfortable but breathing on your own. General anaesthesia is reserved for specific complex cases. The anaesthesia team explains which applies to you the evening before.

Do I go to the ICU after TAVI?

Most patients go to a monitored or high-dependency bed for the first night rather than a full intensive care unit. The rhythm, groin site and blood pressure are watched closely through that night. A full ICU bed is used when a patient came in unstable or something during the procedure warrants it.

Why might I need a pacemaker after TAVI?

The new valve sits against the heart’s electrical conduction pathway, and pressure there can slow the heartbeat enough to need a permanent pacemaker. This happened in 6.6% of patients in PARTNER 3 and 17.4% in the Evolut Low Risk trial, both published in 2019. It is checked every day before discharge.

How many attendants can stay with me?

One attendant stays overnight in the room. We suggest a second family member during the day to handle billing and paperwork, since one person cannot manage both jobs across four days. Outstation families should plan for around a week in Jaipur once travel and pre-admission visits are counted.

What should I bring for a TAVI admission?

All old reports in one dated folder, your actual medicine strips rather than a written list, loose front-opening clothes, non-slip slippers, a shawl, spectacles, hearing aids and a long phone charger. Leave jewellery and large sums of cash at home.

When is my first check-up after discharge?

A wound check at about seven days, then an echocardiogram and review at one month. Most patients are seen again at six months and then once a year. The 2020 ACC/AHA valve guideline recommends this kind of periodic echo follow-up after valve replacement.

Can the stay be longer than four days?

Yes, and it is not a sign the valve failed. A new conduction problem on the ECG, bleeding or swelling at the groin, or a dip in kidney function after the contrast dye can each add a day or two. Patients who came in frail sometimes stay longer simply because home is not yet safe.

The post TAVI in Jaipur, Day by Day: What Actually Happens From Admission to Discharge appeared first on Dr Prem Ratan Degawat.

Jaipur के private hospitals में TAVI का खर्च आमतौर पर 15 से 30 लाख रुपये के बीच रहता है, और इसका सबसे बड़ा हिस्सा valve की कीमत होती है। Government की तय की गई rate इससे कम है। RGHS ने TAVI के लिए 14 लाख रुपये का package रखा है और CGHS ने valve व procedure मिलाकर करीब 13.84 लाख। पर दोनों में शर्तें हैं, और यही शर्तें ज़्यादातर families को हैरान करती हैं।

OPD में यह सवाल हर हफ़्ते आता है। परिवार report लेकर बैठता है, valve बदलने की बात समझ आ जाती है, फिर पहला सवाल यही होता है कि पैसा कहां से आएगा। इस article में सीधी बात होगी: किस scheme में TAVI का क्या status है, कौन सा document पहले से तैयार रखना है, और आखिर में जेब से कितना जाता है।

Jaipur में TAVI का असली खर्च कितना बैठता है

अस्पताल का bill एक number नहीं होता, कई हिस्सों का जोड़ होता है।

सबसे भारी हिस्सा valve है। यही अकेले total का लगभग आधा से दो-तिहाई ले जाता है। Imported valve महंगे हैं, और India में बने valve आमतौर पर 30 से 40 प्रतिशत तक सस्ते पड़ते हैं। दूसरा हिस्सा procedure और cath lab का है। तीसरा ICU और hospital stay का, जो आमतौर पर तीन से पांच दिन रहता है। चौथा pre-procedure workup, जिसमें CT angiography, echo और coronary angiography आते हैं।

इन सबको जोड़कर Jaipur में आम range 15 से 30 लाख बनती है। बहुत जटिल cases में यह 35 लाख तक भी जा सकती है, पर वह अपवाद है। खर्च का हिस्सेवार breakdown TAVI Surgery Cost in Jaipur वाले page पर दिया है, और पूरे India की तुलना TAVI Surgery Cost in India पर।

एक बात मैं हर family से कहता हूं। Valve सस्ता चुनना और मरीज़ की anatomy को नज़रअंदाज़ करना, यह बचत नहीं है। कौन सा valve लगेगा यह CT की measurement तय करती है, budget नहीं। जहां दोनों option medically बराबर होते हैं, वहां मैं खुद सस्ता वाला suggest करता हूं।

RGHS में TAVI cover होता है या नहीं

यह Rajasthan के सरकारी कर्मचारियों और pensioners के लिए सबसे ज़रूरी हिस्सा है, और जवाब आधा हां है।

RGHS की official package list (07.01.2025 वाला Package Code Master) में TAVI मौजूद है। Package code 1885, नाम “Procedure of TAVI – Severe aortic stenosis with severe comorbidities”, rate 14,00,000 रुपये। NABH और non-NABH दोनों के लिए यही rate है।

पर उसी line में एक शर्त लिखी है जो सब कुछ बदल देती है: “Reserved for Government hospitals only”।

इसका सीधा मतलब यह है कि RGHS का यह TAVI package private hospital में cashless नहीं चलता। जो beneficiary Jaipur के किसी private centre में TAVI कराना चाहता है, वह इस package के भरोसे नहीं रह सकता। यह बात पहले दिन पता होनी चाहिए, discharge के दिन नहीं।

RGHS में valve की सर्जरी वाले दूसरे package ज़रूर हैं। Open surgery से valve बदलने का package 535 है, MVR या AVR, rate 1,07,242 रुपये NABH में। Balloon से valve खोलने वाला AVBD package 576 है, 49,991 रुपये। यानी surgical रास्ता और balloon वाला रास्ता RGHS में खुला है, TAVI वाला रास्ता government hospital तक सीमित है।

CGHS वालों के लिए TAVI की rate क्या तय है

Central government के कर्मचारी और pensioners के लिए स्थिति साफ़ है और लिखित है।

CGHS ने 19 दिसंबर 2023 के Office Memorandum (F.No. Z15025/32/2023/DIR/CGHS) में TAVI को नए procedure के तौर पर जोड़ा। इसमें rate दो हिस्सों में दी गई है:

• TAVI/TAVR Implant: 12,84,000 रुपये
• TAVI/TAVR Procedure cost: 1,00,000 रुपये NABH hospital में, 85,000 रुपये non-NABH में

यानी CGHS rate पर कुल करीब 13.84 लाख। ध्यान दीजिए कि RGHS का 14 लाख वाला package इसी के आसपास बैठता है, क्योंकि RGHS की rates CGHS के package rates पर आधारित हैं।

इसमें एक शर्त है जिसे लोग अक्सर देर से पढ़ते हैं। उसी OM में लिखा है कि इन procedures के लिए Director, CGHS की मंज़ूरी, Special Technical Committee से सलाह के बाद ज़रूरी है। यह मंज़ूरी लेने में समय लगता है, इसलिए CGHS beneficiary को paperwork सबसे पहले शुरू करना चाहिए।

Ayushman Bharat (PM-JAY) से TAVI हो पाता है क्या

यहां जवाब साफ़ नहीं में है, और यह कड़वा है पर सही है।

PM-JAY की official package list, Health Benefit Package 2022, में TAVI या TAVR नाम का कोई package है ही नहीं। पूरी list में transcatheter शब्द एक बार भी नहीं आता। जो valve वाला package है वह खुली सर्जरी का है: CTVS category में Aortic valve replacement, procedure code SV005A, rate 1,63,700 से 1,96,400 रुपये तक tier के हिसाब से, और valve की कीमत अलग से जुड़ती है।

दूसरी बात cover की limit की है। PM-JAY में परिवार को साल भर में 5 लाख रुपये तक का cover मिलता है। TAVI का खर्च उससे तीन से छह गुना ज़्यादा है। इसलिए package होता भी, तो 5 लाख की limit अकेले TAVI का bill नहीं संभाल पाती।

पर इसका यह मतलब नहीं कि PM-JAY बेकार है। जिस मरीज़ के लिए खुली सर्जरी medically सही option है, उसके लिए PM-JAY उस सर्जरी को cover करता है। किसके लिए TAVI ज़रूरी है और किसके लिए सर्जरी बेहतर, यह फ़र्क़ TAVI किसे करानी चाहिए पर समझाया गया है, और दोनों रास्तों की कीमत की तुलना Heart Valve Replacement Cost पर।

Rajasthan की Mukhyamantri Ayushman Arogya Yojana में क्या स्थिति है

पुरानी Chiranjeevi Yojana अब Mukhyamantri Ayushman Arogya Yojana कहलाती है, नाम फ़रवरी 2024 में बदला गया। Cover साल में 25 लाख रुपये तक का है, जो PM-JAY से काफ़ी ज़्यादा है, और यह Rajasthan के सरकारी व empanelled private दोनों तरह के hospitals में चलता है।

यहां मैं वही कहूंगा जो verify हो सका है। Valve बदलने की सर्जरी इस scheme के दायरे में आती है। पर MAA Yojana की official package list मुझे नहीं मिल पाई, इसलिए मैं यह दावा नहीं कर रहा कि TAVI इसमें अलग package के तौर पर शामिल है। यह सवाल hospital के scheme desk से नाम और package code के साथ पूछिए, किसी advertisement या दूसरी website के भरोसे मत रहिए। Coverage को लेकर गलत उम्मीद बांधना, ठीक उसी दिन टूटती है जिस दिन पैसे की सबसे ज़्यादा ज़रूरत होती है।

एक काम की बात, follow-up का खर्च scheme में अलग से देखा जाता है। TAVI के बाद की दवा, echo और checkup का क्या हिसाब रहता है, यह TAVI के बाद घर पर क्या करें वाली guide में भी छुआ गया है।

एक नज़र में कौन सी Scheme क्या देती है

Private insurance से TAVI का claim कैसे pass होता है

ज़्यादातर families के लिए असली रास्ता private policy ही होती है। यहां तीन चीज़ें तय करती हैं कि claim निकलेगा या नहीं।

पहली, sum insured। अगर policy 5 लाख की है और bill 20 लाख का, तो बाक़ी जेब से जाएगा। Corporate policy और personal policy दोनों हों, तो दोनों का इस्तेमाल हो सकता है।

दूसरी, waiting period। Aortic stenosis अक्सर पहले से मौजूद बीमारी मानी जाती है, यानी pre-existing disease। IRDAI की 1 अप्रैल 2024 से लागू Insurance Products Regulations 2024 के बाद PED का ज़्यादा से ज़्यादा waiting period 4 साल से घटकर 3 साल रह गया है, और moratorium 8 साल से घटकर 5 साल। कई policies में यह अवधि इससे भी कम रखी गई है, इसलिए अपनी policy का wording देखिए, आम धारणा नहीं।

तीसरी, room rent और sub-limit। ICU का rent और कुछ consumables पर limit लगी हो, तो approved रकम bill से कम निकलती है। यह सबसे आम कारण है जिससे families को अंत में उम्मीद से ज़्यादा भरना पड़ता है।

Cashless चाहिए तो pre-authorisation planned procedure के तौर पर पहले भेजिए। Emergency में reimbursement भी चलता है, पर उसमें पैसा पहले आपका लगता है।

Pre-authorisation के लिए कौन से document तैयार रखें

यह list सामने रखकर काम शुरू करेंगे तो approval में दिन बचेंगे।

1. मरीज़ का photo ID और policy card या scheme card
2. Echo report जिसमें aortic stenosis severe लिखा हो
3. CT angiography की report, valve की measurement के साथ
4. Coronary angiography की report
5. Treating cardiologist का लिखा हुआ line of treatment और estimate
6. पुराने hospital records और चल रही दवाओं की list
7. उम्र, comorbidity या पिछली सर्जरी का ब्योरा, जिससे यह साबित हो कि खुली सर्जरी का risk ज़्यादा है

आखिरी point सबसे ज़्यादा वज़न रखता है। Insurer या scheme यह देखना चाहता है कि TAVI इस मरीज़ के लिए पसंद नहीं, ज़रूरत है। मैं यह justification खुद लिखकर देता हूं, क्योंकि इसी एक page पर कई claims अटकते हैं।

Paperwork कौन संभालता है और इसमें कितना समय लगता है

Hospital का insurance और TPA desk pre-authorisation भेजता है, और cardiology team medical justification देती है। Planned cases में approval आमतौर पर कुछ working days में आता है, पर scheme वाले cases में committee की मंज़ूरी लगे तो यह लंबा खिंच सकता है।

यहां मेरी एक साफ़ राय है, और यह सबसे ज़रूरी बात है जो इस पूरे article में है। Severe symptomatic aortic stenosis का इलाज approval का इंतज़ार करने के लिए नहीं रुकना चाहिए। जिस मरीज़ को बेहोशी आ चुकी है, या चलने पर सांस फूल रही है, उसके लिए हफ़्तों की देरी खतरनाक है। ऐसे में हम paperwork और clinical तैयारी साथ-साथ चलाते हैं, और ज़रूरत पड़ने पर balloon valvuloplasty से मरीज़ को stable रखकर समय निकालते हैं। पैसा जुटाने में लगने वाला वक़्त असली दिक़्क़त है, यह मैं मानता हूं, पर उसका हल इलाज टालना नहीं है।

आखिर में families की जेब से कितना जाता है

ईमानदार जवाब यह है कि यह तीन चीज़ों पर टिका है: valve कौन सा लगा, policy कितनी बड़ी है, और cover scheme से मिला या insurance से।

• अच्छी sum insured वाली private policy और Indian valve हो, तो out of pocket हिस्सा अपेक्षाकृत छोटा रह सकता है
• कम sum insured या sub-limit वाली policy में 5 से 10 लाख तक अपना लगना असामान्य नहीं है
• Scheme पर पूरी तरह निर्भर government hospital का रास्ता चुना जाए, तो खर्च सबसे कम रहता है, पर waiting और उपलब्धता अलग सवाल हैं

Jaipur में structural heart के इलाज, टीम और सुविधा की जानकारी Jaipur में TAVI/TAVR विशेषज्ञ वाले page पर है।

Dr. Prem Ratan Degawat की सलाह

पैसे की योजना बनाने में जो families सबसे कम परेशान होती हैं, वे तीन काम शुरू में ही कर लेती हैं।

पहला, hospital से लिखित estimate लीजिए, ज़ुबानी अंदाज़ा नहीं। उसमें valve, procedure, ICU और workup अलग-अलग लिखे हों, ताकि आप insurer को साफ़ tally दे सकें।

दूसरा, scheme या insurer से package का नाम और code लिखित में पूछिए। “Cover हो जाएगा” कहने वाला जवाब claim के दिन काम नहीं आता। RGHS के मामले में तो यह और ज़रूरी है, क्योंकि package की शर्त ही उसे private hospital से बाहर कर देती है।

तीसरा, घर में मौजूद हर policy निकालिए। कई परिवारों में मरीज़ के बेटे या बेटी की corporate policy में माता-पिता पहले से शामिल होते हैं और किसी को याद नहीं रहता। मैंने कई बार देखा है कि यही भूली हुई policy सबसे बड़ा हिस्सा उठा लेती है।

और एक चेतावनी। “Scheme से पूरा free हो जाएगा” कहने वाले बिचौलियों से बचिए। Package code और शर्तें सरकारी दस्तावेज़ में लिखी हैं, किसी की बात पर नहीं।

आख़िर में

Jaipur में TAVI का खर्च 15 से 30 लाख के बीच रहता है, और सरकारी schemes की तय rate इससे कम है। पर हर scheme की अपनी शर्त है। RGHS का TAVI package government hospitals तक सीमित है, PM-JAY में TAVI का package है ही नहीं, और CGHS में मंज़ूरी की प्रक्रिया से गुज़रना पड़ता है। ज़्यादातर private hospital के मरीज़ों के लिए असली सहारा उनकी अपनी health policy बनती है।

इसलिए दो काम साथ चलाइए: paperwork जल्दी शुरू कीजिए, और इलाज का फ़ैसला approval के इंतज़ार में मत टालिए। Aortic stenosis के मामले में समय की क़ीमत पैसे से ज़्यादा है। खर्च और cover पर अपने case के हिसाब से बात करने के लिए Dr. Prem Ratan Degawat से Jaipur के Eternal Hospital में +91-8960594076 पर appointment book करें।

डॉ. प्रेम रतन डेगावत के बारे में

डॉ. प्रेम रतन डेगावत जयपुर के अनुभवी इंटरवेंशनल कार्डियोलॉजिस्ट हैं, जो स्ट्रक्चरल हार्ट प्रोसीजर में विशेषज्ञता रखते हैं। वे वर्तमान में इटरनल हॉस्पिटल में TAVR और स्ट्रक्चरल हार्ट डिजीज प्रोग्राम के एसोसिएट डायरेक्टर हैं। उन्होंने 600 से अधिक TAVI प्रोसीजर किए हैं, जिनमें बाईकस्पिड वाल्व और वाल्व इन वाल्व जैसे जटिल केस भी शामिल हैं।

उन्होंने किंग जॉर्ज मेडिकल यूनिवर्सिटी, लखनऊ से DM कार्डियोलॉजी की पढ़ाई पूरी की है और इटली के IRCCS ह्यूमैनिटास रिसर्च हॉस्पिटल में एडवांस्ड ट्रेनिंग ली है। डॉ. डेगावत TAVI, मिट्राक्लिप, TRI-Clip, TMVR जैसी प्रोसीजर में प्रमाणित भारत के गिने-चुने कार्डियोलॉजिस्ट में से एक हैं।

इलाज के खर्च और cover को लेकर डॉ. डेगावत मरीज़ और परिवार को शुरू में ही साफ़ तस्वीर देते हैं, ताकि फ़ैसला पूरी जानकारी के साथ लिया जा सके।

कंसल्टेशन डिटेल:

• हॉस्पिटल: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD समय: सोमवार से शनिवार, सुबह 10 बजे से शाम 4 बजे तक
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• संपर्क: +91-8960594076

Book an appointment today

FAQs:

क्या RGHS से Jaipur के private hospital में TAVI cashless हो सकती है?

RGHS की package list में TAVI का package 1885 मौजूद है, पर उस पर साफ़ लिखा है कि यह सिर्फ़ government hospitals के लिए reserved है। इसलिए private centre में इसी package के आधार पर cashless नहीं मिलेगा। अपने case के लिए मौजूदा स्थिति hospital के RGHS desk से लिखित में पूछें।

Ayushman Bharat card से TAVI हो जाएगी?

PM-JAY की HBP 2022 list में TAVI या TAVR का कोई package नहीं है, और परिवार का सालाना cover 5 लाख रुपये है। खुली सर्जरी से valve बदलना इसमें आता है, TAVI नहीं। जिस मरीज़ के लिए सर्जरी सही option है, उसके लिए यह cover काम का है।

TAVI में सबसे ज़्यादा पैसा किस चीज़ पर लगता है?

Valve पर। यही अकेले कुल खर्च का लगभग आधा से दो-तिहाई हिस्सा होता है। India में बने valve imported के मुक़ाबले करीब 30 से 40 प्रतिशत सस्ते पड़ते हैं, और कई मरीज़ों में medically बराबर काम करते हैं।

Insurance company aortic stenosis को pre-existing मान ले तो क्या होगा?

तब policy का waiting period लागू होता है। IRDAI के 2024 के नियमों के बाद PED का अधिकतम waiting period 3 साल है, और 5 साल के moratorium के बाद non-disclosure के आधार पर claim रोका नहीं जा सकता। अपनी policy का wording ज़रूर पढ़ें, क्योंकि कई policies में यह अवधि कम होती है।

Approval का इंतज़ार करते हुए इलाज टालना ठीक है?

नहीं। Severe symptomatic aortic stenosis में देरी जानलेवा हो सकती है। Paperwork और clinical तैयारी साथ चलनी चाहिए, और ज़रूरत पड़ने पर balloon valvuloplasty से मरीज़ को कुछ समय के लिए stable रखा जा सकता है।

यह article जानकारी के लिए है और किसी doctor की सीधी सलाह की जगह नहीं ले सकता। Scheme की rates और शर्तें समय के साथ बदलती हैं, इसलिए इलाज से पहले hospital के insurance या scheme desk से मौजूदा स्थिति ज़रूर confirm करें।

The post TAVI ka Kharcha Jaipur Mein: RGHS, Ayushman Bharat और Insurance से कितना Cover होता है appeared first on Dr Prem Ratan Degawat.

Seven patients treated by Dr. Prem Ratan Degawat at Eternal Hospital, Jaipur have described their TAVI on camera. Every video is on this page, and the accounts below come from what they actually say in them.

Six are from Rajasthan. One travelled from Delhi. Their ages run from 65 to 80, and between them they carry insulin-dependent diabetes, old stents, a pacemaker and one cardiac arrest.

Mrs. Om Panwar is 80. She says her valve was changed “through a wire,” which is a better description of TAVI than most textbooks manage.

One thing worth knowing before you read. Each of these patients was chosen for TAVI after their scans showed it was a good fit, which is exactly how the decision should be made. Whether it fits you is a question only your own echo and CT can answer, and there is no single answer that covers everybody. That is a good conversation to have early rather than late.

The seven patients

Turned away closer to home

Mr. Manak Chand Hiran, Bhilwara

He went home at two in the afternoon to eat and suddenly felt dizzy and sweaty. The doctor he saw in Bhilwara would not take the case on, so the family drove to Jaipur and he came in through emergency.

The valve was not dealt with first. He needed a pacemaker, done over two days. He then told Dr. Degawat he wanted open surgery, thought about it overnight, and changed his mind the next morning.

His summary: “No cut, no bleeding, nothing at all.”

Dr. Degawat’s note: calcium that stiffens the aortic valve sits against the heart’s electrical wiring, so rhythm trouble and valve trouble often arrive together. Treating them in sequence is routine, not a sign something went wrong.

Mrs. Om Panwar, 80

Breathless for years and much worse recently, she went to three or four places. Each told her the same thing, that this could only be done at a big hospital.

Her account is short and worth quoting: “Eternal Hospital, where Prem Ratan ji is, who truly became like a son to me. He did my surgery very well. He did it through a wire.”

Her age is why several doctors hesitated. It is also, medically, why TAVI suited her. The older and frailer a patient is, the worse the arithmetic of opening a chest becomes.

Told they were too complicated

Mrs. Maya Devi, Jaipur

Her son Pawan Goyal talks. She is 65, diabetic on insulin, hypertensive, already carrying two stents, and by the time he brought her in she could not walk.

He was told her age made surgery difficult. “At first I did not believe it,” he says about the alternative. Then: “The first thing he did was end my mother’s fear. He explained it on paper, the way a teacher explains to a student.”

She walked the same day. “No pain anywhere, no cutting anywhere.”

Insulin, previous stents and weakness all punish a healing sternum far more than they punish a small puncture in the groin. On paper she looks like the difficult patient. In practice every one of those things argued for a catheter.

One correction. He remembers being told the whole thing takes an hour. The implant often does, the day around it does not.

Mr. Suresh Chand Bagdi, Sawai Madhopur

His daughter Aruna speaks first, and hers is the hardest account here. Her father’s breathing had become like suffocation. He went on to throw a pulmonary embolism and arrest.

He then speaks for himself. Other doctors had told him the valve would have to be changed, and he finishes with “today I am completely well, he saved my life.”

Two moments in that video are worth a doctor’s word.

Aruna says TAVI carries no risk and no side effects. You can hear the relief in her voice, and after what her father came through that is easy to understand. The fuller picture is that TAVI is a low-risk procedure rather than a no-risk one. Stroke, a groin artery needing repair, bleeding, kidney strain from the contrast dye, a small leak around the new valve or a pacemaker are all uncommon, and your team will talk you through each one beforehand.

She also mentions discharge in 24 hours. Some patients genuinely do go home that quickly. Two to five days is more typical, and a little longer is completely normal for anyone who arrives as unwell as her father did.

Her father is closer to right than he sounds. TAVI does not cut the old valve out. The new one opens inside it, pushes the old leaflets aside and takes over immediately.

Referred in by another cardiologist

Mr. Lalit Khurana

A routine echo came back with the aortic valve numbers wrong and the score higher than it should have been. A cardiologist at the same hospital, a family friend, sent him to Dr. Degawat.

What makes him unusual on this page is that he was not desperate. No ambulance, no breathlessness at a standstill. He came in on a bad report.

“The best part is the speedy recovery,” he says. “It is non-surgical, there is no hesitation of any kind, the procedure only takes a little while.”

He is the version Dr. Degawat would like to see more often. Not a rescue.

Mrs. Ugam Lata Gangwal, Kishangarh

Her grandson Deepanshu talks, and the important line is his first: “Earlier she would get breathless walking, and even sitting and talking.”

Breathless while walking is the early complaint. Breathless while sitting and talking means the heart cannot cope even when nothing is asked of it. That is late aortic stenosis, and it is the stage where acting quickly makes the biggest difference. If that sentence describes someone at home, read the symptoms of aortic stenosis and when to act on them tonight.

The family went home for two days, read about valve replacement, and came back having decided. She was three days post-procedure at filming and waiting to go home.

The one who came from Delhi

Mr. Ratan Kumar Goyal, Delhi

Breathlessness was closing his life down, and early tests pointed at the heart. The family found out everything they could before committing to anything, and that search ended in Jaipur.

“He explained everything to us in detail,” he says, then: “we came here from Delhi, the whole family.”

The procedure was done on the 20th. “Now I am feeling completely fine. I have no trouble of any kind.”

Who TAVI suits best

These seven all did well, and the honest reason is that each was a good candidate. Choosing the right patient is most of the work, so it is worth knowing what that choice rests on.

TAVI suits some people far better than others. A patient under 65 at low surgical risk, built for an operation, is usually better served by the operation. The ten-year data is good and the data past that is thinner, which matters enormously if you might live another thirty years. It is a genuine judgement call, so ask for the reasoning behind whatever you are advised. The real numbers sit in the guide to how long a TAVI valve lasts.

Anatomy matters too. Groin arteries too small or too diseased to take the delivery system. Certain bicuspid valves. A coronary artery sitting low enough that pushing the old leaflet aside could block it.

The valve also has to be the thing actually holding you back. Where advanced lung disease, cancer or frailty is setting the limit, treating the valve alone will not change how someone feels day to day, so it is worth being sure first.

On money, plan for ₹15 lakh to ₹30 lakh at private centres in India, and the valve itself is most of that. The breakdown is on the TAVI cost page for Jaipur.

Before the first appointment

In five of these seven videos the person doing the talking is a son, a daughter, a grandson or a wife. If that is you, this part is yours.

Bring the echo report with the aortic valve gradient and valve area on it, the ECG, any CT angiogram, the medicine list, and recent kidney function and haemoglobin. Without the echo numbers everyone is guessing.

Then ask five things and write the answers down.

• What is the surgical risk score and what does it mean here?
• Are the groin arteries good enough, or is another route needed?
• Which valve is planned, and why that one?
• What is the operator’s own pacemaker rate with it?
• If this wears out in twelve years, what happens then?

If the answers are vague, get a second opinion before heart surgery. Two of the people on this page are here because somebody said no first.

What seven people add up to

Seven patients. Six from Rajasthan and one from Delhi, aged 65 to 80, carrying insulin-dependent diabetes, old stents, a pacemaker, a pulmonary embolism and a cardiac arrest between them. Not one was opened up, and all seven are on camera saying so.

Every case is decided on its own echo, CT and arteries. What these seven do show is that being older, diabetic, previously stented or already turned down for surgery does not mean nothing can be done. Very often, a great deal can.

Bring the reports and have them looked at properly. You can check who qualifies for TAVI first, and if you want the procedure explained from scratch, start with what TAVI is and how the valve is placed.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Contact: +91-8960594076

Book an appointment today

FAQs:

Are these real TAVI patients?

Yes. All seven appear on camera under their own names, most with a family member beside them, at Eternal Hospital in Jaipur. Every video is embedded above. Nothing here is invented, and where a patient said something medically wrong, the text corrects it.

How soon do TAVI patients walk after the procedure?

Mrs. Maya Devi was walking the same day and Mrs. Gangwal went home on day three. That is normal for a straightforward case, but it is not a promise. Patients who arrive very weak, or who need a pacemaker too, take longer than the videos suggest.

Can TAVI be done if a hospital near me said no?

Often, yes. Mr. Hiran was refused in Bhilwara and Mrs. Om Panwar was turned away by three or four places. Being high risk for open surgery is the situation TAVI was designed for, so get the echo and CT reviewed before accepting a no.

Is 80 too old for TAVI?

No. Mrs. Om Panwar was 80. Age on its own decides nothing. Kidney function, lungs, frailty and what the arteries look like on CT decide it, and some of those can be improved before the procedure.

Does TAVI remove the old valve?

No, and this confuses almost everyone. The old valve stays where it is. The new one opens inside it, pushes the stiff leaflets aside and starts working immediately. Nothing is cut out, which is a large part of why the chest never has to be opened.

Can a diabetic patient on insulin have TAVI?

Yes, and diabetes usually strengthens the argument for it. Mrs. Maya Devi was on insulin with two previous stents. Diabetes punishes a healing sternum far more than it affects a small puncture in the groin.

Do patients travel to Jaipur for TAVI?

Regularly. The people on this page came from Bhilwara, Kishangarh, Sawai Madhopur, Jaipur and Delhi. Most send echo and CT reports ahead, travel for the assessment and procedure, then do follow-up scans locally.

The post TAVI Patient Stories: 7 Real Recoveries from North India appeared first on Dr Prem Ratan Degawat.