Frail And Breathless At 94, Woman Overcomes Severe Breathlessness After Life-Saving Heart Procedure

As a cardiologist, I've had many cases, but few that impacted me as powerfully as that of Mrs. Bhanbai Gala, a 94-year-old woman from Mumbai in India, who survived with determination to attend her great-grandson's wedding after accepting to go under the revolutionary Transcatheter Aortic Valve Replacement (TAVR) surgery.

Mrs. Gala, thin and only 36 kg in weight, had been having severe aortic stenosis, which made her aortic valve narrow and limited blood passage. She complained of chronic chest heaviness and shortness of breath, precluding her from walking more than a few meters. Due to her bypass operation history in 2010 and her poor state, she was highly susceptible to open-heart surgery. Her family, particularly her granddaughter, Dr. Mita Gala—a general practitioner—was much concerned with her health condition.

Mrs. Gala did have a wish though: she desired to attend the wedding of her great-grandson. This tender aspiration pushed her family towards attempting medical remedies for her illness even with the attendant risks.

Following careful consideration, I advised TAVR, a minimally invasive procedure to replace the stenosed aortic valve without open-heart surgery. Due to her advanced age, history of cardiac disease, and petite stature, the procedure was fraught with risk. Nevertheless, with careful planning and precise execution, we believed that we could provide her with a new quality of life.

The operation was done under local anesthetic. Using a catheter placed through the femoral artery, we replaced her failing aortic valve within an hour. In spite of her complicated anatomy and pre-existing trifascicular AV block, the new valve worked immediately, enabling her to breathe more comfortably during the night.

Within 48 hours, Mrs. Gala was discharged from the hospital. At her one-month follow-up, she was doing amazingly well—she was walking comfortably, going about her household activities, and even making her favorite dessert, Khajur Pak. Her turnaround was nothing short of inspiring.

Her family, initially hesitant about the procedure, was flooded with joy. Dr. Mita Gala, who too had her reservations as a doctor, was extremely thankful. "As a physician, I was unsure of the safety of TAVR for my grandmother, but Dr. Rao's knowledge and continuous guidance put our minds at rest," she stated. "Watching her experience the wedding traditions with such zest was a blessing indeed."

Mrs. Gala's story is a testament to the remarkable progress in interventional cardiology. TAVR has been a game-saver for patients with severe aortic stenosis, providing a safe and effective option, even for high-risk procedures. With each passing year, our experience with the procedure has enabled us to customize therapies to fit complicated anatomical and physiologic states, providing the optimal results.

Though long considered for patients who are not candidates for open-heart surgery, TAVR is increasingly being offered to younger, low-risk patients in their 60s if the valve can be replaced through the femoral artery. The success of these cases adds to the increased use of the procedure globally.

Since it was first applied in India in 2011, the TAVR procedure has been on the rise. With an estimated prevalence of 7.3% for isolated aortic stenosis alone, it's estimated that close to 300,000 individuals in India may be eligible for TAVR. The potential to deliver a life-enhancing therapy to an elderly patient such as Mrs. Gala is a reflection of the advancement of cardiology and the life-altering power of medical innovation.