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Thursday 28 February 2019

Ministry of Health Announces Tamil Nadu to be the pioneering state in the country

Ministry of Health Announces Tamil Nadu to be the pioneering state in the country for Heart Valve Treatments

The ministry of health headed by hon’ble health minister Dr C Vijaybaskar, presided a public awareness programme on heart valve replacements without open heart surgery called TAVI on 27th February at Tamil Nadu Government Multi  Super-speciality Hospital, Omandurar. This was the first awareness programme in the country conducted by patients for patients to spread awareness on newer heart valve treatments without open surgery.

 Heart Valves

The heart like any complex pump has valves within it. The heart has four valves (Figure 1). Valve dysfunction can occur leading to symptoms such as chest pain, shortness of breath, loss of consciousness, light headedness and fluid accumulation. Heart Valve dysfunction can occur due to abnormal defects from birth or acquired due to degeneration or rarely due to infection of valves. Awareness and experience in treating heart valve conditions are vital for prompt recognition as treatment in a timely manner can completely cure patient’s symptoms and alter quality of life positively.

 Figure 1: Heart Valves

The commonest valve abnormality due to age related degeneration is narrowing of the aortic valve. This is referred to as aortic stenosis (Figure: 2). The aortic valve is the main valve through which blood has to get out to the rest of the body. Narrowing of this valve leads to significant symptoms and the best definitive treatment for this condition is replacement of the aortic valve with a new artificial valve. This is done surgically through open heart surgery. This is very well established and efficacy proven treatment for aortic stenosis.

Figure 2: Aortic Stenosis (Top panel) and Surgical Treatment (Bottom Panel)

However, not all patients can undergo open heart surgery as these patients are all elderly and they may not be fit to undergo open heart surgery. In addition, some patients may be too old or frail or have other diseases including lung disease, kidney disease, etc that make them high risk for conventional surgical valve replacement. More recently valve replacement can be done without open heart surgery through a key-hole procedure from the groin. This treatment is referred to as Transcatheter Aortic Valve Implantation (TAVI). This is now a well established treatment in the world and is the first line treatment for many specific valve diseases and patients. This allows most patients to have their valve replacement and walk out of hospital in 3-5 days time. The recovery for patients is therefore much quicker compared to open heart surgery. Patients do not have a scar on their chest. This technology has been available and widely used in Europe and America and few parts of Asia since 2004. These technologies, including the valves have been used for many years around the world and have been found to be similar in performance and longevity to surgically replaced valves.

TAVI Procedure Illustration

However, this treatment has not been available in India for routine use until recently. It was introduced to Tamilnadu by Dr A B Gopalamurugan in June 2015 who is a world expert and pioneer in heart valve treatments without open surgery in India. There have been several cases performed since then which have been predominantly an expensive treatment only confined to the private hospitals. As many such elderly patients in the government sector had no access to this treatment, the ministry of health and government of Tamil Nadu put together a programme for the government hospitals.


Tamilnadu government becomes the first state government in the entire country to start these treatments in the government sector. The government of Tamil Nadu in an effort to start such treatments has signed a contract with India’s pioneer in heart valve replacements without open surgery Dr A B Gopalamurugan, senior consultant interventional cardiologist and chief of endovascular treatments at HeartTeam India, Kauvery Hospital, Chennai to lead this programme.

Honourable health minister Dr C Vijayabaskar has put protocols in place to initiate TAVI for the needy and nominated Tamilnadu Government Multi Superspeciality hospital at Omandurar as the dedicated centre to focus on such treatments for government hospital patients across Tamil Nadu. Through a public-private partnership, specialists have been nominated to render such treatments in the government sector. The officials today confirmed that Dr A B Gopalamurugan who introduced such treatments to India and Tamilnadu, has done one of the maximum valve replacement procedures without open surgery called TAVI in India. The Health minister today appreciated Dr Gopalamurugan and Dr Prashant Vaijyanath of HeartTeam India who have done several first in the world treatments and several first in India treatments to come forward to initiate such treatments in the government sector to help the needy.

Two patients with low socio-economic backgrounds were the first patients to receive valve replacement without open surgery called TAVI At Omandurar hospital in December 2018. Patients Mr Nallasamy and Mr Subburam who had their valve replacements at Omandurar were literally walking the next day and they could not believe such quick recovery and return to normal quality of life was possible after a heart valve replacement procedure. The procedures were performed by Dr A B Gopalamurugan and Dr Prashant Vaijyanath from HeartTeam India, Kauvery Hospital, Chennai along with the team at Omandurar Dr G Karthikeyan, head of department for cardiology, Dr Parthasarathy, head of the department for Anaesthesia, Dr Manohar, head of the department for cardiac surgery and allied professionals. Speaking at the event, the officials confirmed that the procedures were performed completely free of cost through the government scheme. The coordination at Omandurar was led by Dr Anand, Nodal officer at Omandurar hospital who was congratulated by the health minister. At a speech by the Director of Omandurar Hospital Dr Umanath IAS, he concluded that its a great step forward for the Government Hospital and the people of Tamil Nadu and he thanked the Health Minister for making such treatments possible in the Government sector and for becoming the first state government in the country to perform TAVI.

Many elderly patients who require valve replacements are unaware that such treatments like TAVI exists that does not require open heart surgery and that they can recover much quicker with less risk. To spread awareness, many patients who have had TAVI across the state of Tamil Nadu and Kerala came forward today to share their experiences after such TAVI procedures. There were several patients who had undergone previous heart valve surgery through conventional open surgery who later required a second valve replacement. Such patients had also been treated with a TAVI procedure thereby negating the need for a second open heart surgery. Present at the event were several patients who have had valve replacements without open surgery (TAVI) including India’s youngest patient, India’s oldest patient, India’s first mitral valve replacement, Actor Kathadi Ramamurthy and others who were all treated by Dr A B Gopalamurugan successfully over the years. They shared their experiences and how they have had valve replacement without surgery and got discharged in just 2 days

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