At the age 86, Saradhal Alagappan is India’s oldest patient to receive the MitraClip, a revolutionary cardiac therapy which is transforming the lives of India’s elderly cardiac patients. When Saradhal was hospitalized recently, she was found to have torn a chord that was essential for the functioning of a valve in her heart. This caused the valve to leak heavily and pushed her into heart failure. Her symptoms were so severe that over the past year she has been hospitalized 6 times and was confined to a wheelchair due to shortness of breath. She was refused surgery due to her age and frailty, and medication was no longer able to control her symptoms.
Now, thanks to the MitraClip, she is enjoying badminton rallies with her grandchildren.
“This is just one story. There are many such stories of the elderly getting back to active lifestyles after such therapies,” says Dr Sai Satish, Senior Interventional Cardiologist at Apollo Hospitals, “And many more stories are waiting to happen.”
When Dr Sai Satish talks about the elderly and their heart, his passion for improving their lives comes through in his enthusiasm for providing them with hope. “My oldest patient is 103 years old, and he just had his birthday party. He and his family were so, so happy. We think that some people are too old for surgery, which is perhaps true – but there are other ways to improve their lives,” says Dr Sai Satish, who is also a practicing interventional cardiologist & faculty in one of the world’s best TAVR training centres, the Gottsegen Institute of Cardiology in Budapest, Hungary.
The aging hearts of India
While India is usually considered a young country, with half the population being below 25 years of age, the other end of the age spectrum is growing steadily. It is predicted that by 2050, our senior citizens will treble in number, with 434 million under the ‘oldest old’ category (aged 80 and above). This is of no surprise given the rapid increase in life expectancy in recent years and the increasing number of citizens opting out of parenthood.
“Of course, age is just a number, and so are the aged. But that is the case only until we add a few more statistics to this picture,” Dr Sai Satish cautions. He points out that according to the Government of India, cardiovascular disorders account for one-third of elderly mortality. As we age, the wear and tear of different valves of the heart only increases.
“Take the aortic valve for instance. It opens when the heart contracts to allow blood to pass from the left ventricle into the aorta, the body’s main artery. When this valve begins to get narrow due to age and other factors, it restricts blood flow creating a serious and potentially life-threatening condition that is called aortic stenosis,” Dr Satish explains.
Inside the heart. (via Wikimedia commons.)
“Every year we diagnose more than a million cases of aortic stenosis in India,” he points out emphatically, “It is estimated to affect 1 in 8 people over the age of 75. It also has a higher mortality rate than most cancers. Once severe aortic stenosis is diagnosed, patients have an astounding mortality of 90% in 4 years if left untreated.”
Sadly, most octa- & nonagenarians don’t have many avenues of treatment available to them. Their advanced years often result in them presenting with two or more diseases, what is referred to by doctors as co-morbidities. “Surgery is rarely an option and so most physicians rely on medical management of heart conditions. This approach works to add longevity to our geriatric patients. However in many cases, it also lowers their quality of life, slowing them down steadily, until their lives become confined to their beds,” says Dr Sai Satish. But this can change.
Never too old, thanks to technology
Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve implantation (TAVI) is a minimally invasive procedure that is performed on a beating heart, and does not require cardio-pulmonary bypass. Nor does it require "blood thinners" like mechanical heart valves usually do. Instead, revolutionary valves, constructed from a combination of metal mesh and animal tissue, are delivered via a thin wire (catheter) usually through the femoral artery and then expanded in place. Following the procedure, a patient can be home and active in less than 5 days.
“Similar to coronary angioplasty, the entire procedure is performed in a cardiac Cath-lab most often under just sedation and local anaesthesia,” Dr Sai Satish explains.
Dr Sai Satish, established India’s first dedicated International TAVR training centre at Apollo Hospitals, Chennai and has trained doctors from over 20 countries in TAVR. A pioneer in the field, he holds the reputation for having performed the highest number of MitraClip implants in the subcontinent till date.
A vast variety of cases have been treated very successfully with TAVR including 90-year-olds with severely calcified & damaged valves, bicuspid or 2-leaflet aortic valves, aortic valves with metallic surgically implanted mitral valves nearby, surgically replaced aortic valves that have failed and even patients with heavily leaking aortic valves, he says.
Another condition that commonly presents itself in senior citizens is mitral regurgitation. Mitral regurgitation is a condition in which the heart's mitral valve leaflets do not close tightly. As a result, blood flows backward from the heart's left ventricle into the left atrium. The heart must then work harder to push blood through the body, which can cause fatigue, shortness of breath and in extreme cases, heart failure. “The MitraClip repairs the mitral valve by clipping its leaflets together, and that is how we treated Saradhal. This drastically improves outcomes in patients, lowering hospitalizations and improving their quality of life with fewer symptoms,” he says. The MitraClip has been used in over 50,000 patients from across the world till date. Introduced in India last year, this revolutionary procedure is now treating leaking mitral valves in critically-ill, and inoperable heart failure patients giving them a second lease of life.
This article has been produced by TNM Marquee in association with Apollo Hospitals and not by TNM Editorial.