TAVR Surgery at Apollo Hospitals, Lucknow

Why Patients Choose Apollo Hospitals Lucknow for TAVR

• A structural heart team, not a single specialist. TAVR at Apollo is planned by a Heart Team that brings together interventional cardiologists, cardiac surgeons, cardiac anaesthetists, cardiac imaging specialists and critical care physicians, which is the model recommended by international and Indian valve-intervention guidance.
• Apollo Group legacy of over 40 years. The Apollo Hospitals group began in 1983 and has grown into one of Asia's largest integrated healthcare networks, with more than 70 hospitals and one of the largest cumulative cardiac surgery and cardiac intervention volumes in the private sector in India.
• Cardiac sciences depth at Lucknow. The Lucknow unit runs a full cardiac sciences department covering interventional cardiology, electrophysiology and pacing, cardiac surgery and heart failure care, with round-the-clock cath lab and cardiac ICU cover. The exact number of consultants and their individual experience is best confirmed with the cardiac sciences desk, as the panel changes over time.
• Diagnostics that decide TAVR suitability are available in-house. Transthoracic and transoesophageal echocardiography, CT aortography with annulus sizing and access-vessel assessment, coronary angiography, and pulmonary function and frailty assessment are all done under one roof, so patients from outside Lucknow do not have to shuttle between centres.
• Modern hybrid cath lab environment. TAVR is performed in a cath lab with high-resolution fluoroscopy, haemodynamic monitoring, pacing support and immediate surgical backup, which is what allows a transfemoral, mostly conscious-sedation approach in suitable patients.
• Care pathways tailored by age and risk. Separate pathways exist for elderly and frail patients (frailty scoring, delirium prevention, early mobilisation), for patients with kidney disease (contrast-minimising protocols), for younger patients with bicuspid or rheumatic valve disease where surgery may still be the better choice, and for paediatric and congenital valve disease, which is handled by the paediatric cardiology and cardiac surgery route rather than TAVR.
• Continuity after discharge. Structured follow-up with echocardiography, rhythm review for conduction problems, dental and endocarditis-prevention counselling, and cardiac rehabilitation advice adapted to Indian home life.

Overview

Transcatheter Aortic Valve Replacement (TAVR), also called TAVI, is a catheter-based procedure used to treat aortic stenosis, a condition in which the heart's aortic valve narrows and restricts blood flow out of the left ventricle. At Apollo Hospitals Lucknow, TAVR is delivered as a structured, team-based service using current-generation valve systems and detailed pre-procedure imaging. The cardiology and cardiac surgery teams build an individual plan for each patient, with emphasis on safety, comfort and honest discussion of what the procedure can and cannot achieve.

TAVR is not a cure for heart disease and is not right for everyone with a narrowed valve. Its role, the choice between TAVR and open surgical valve replacement, and the expected benefit in a particular patient are decided after evaluation. Apollo Hospitals Lucknow is a recognised name for cardiac care in Uttar Pradesh, and the aim of this page is to help patients and families understand the procedure well enough to ask the right questions.

Why TAVR Surgery is Necessary

Untreated severe aortic stenosis can lead to serious complications, including heart failure, arrhythmias, fainting and death. Once symptoms appear, valve replacement is the only treatment shown to change the natural history of the disease; medicines can ease symptoms but cannot reopen the valve. TAVR is considered for patients with symptoms such as breathlessness on exertion, chest tightness, unusual fatigue, dizziness or blackouts caused by severe aortic stenosis. Its benefits include:

• Minimally invasive approach: Unlike traditional open-heart surgery, TAVR is usually performed through a small puncture or incision in the groin, which generally reduces recovery time and hospital stay.
• Improved quality of life: Many patients report meaningful improvement in breathlessness, stamina and day-to-day function after the procedure.
• Lower risk for high-risk patients: TAVR is particularly valuable for older patients and those with other illnesses that make open surgery hazardous, such as previous cardiac surgery, poor lung function or significant frailty.

At Apollo Hospitals Lucknow, current-generation valve technology and detailed pre-procedure planning are used to work towards the best achievable outcome for each patient, while being clear that outcomes depend on the individual's overall health.

Risks of Delay

Delaying treatment of severe symptomatic aortic stenosis can have serious consequences. As the obstruction progresses, the heart muscle thickens and stiffens, and the left ventricle comes under increasing strain. This can result in:

• Worsening symptoms: More severe breathlessness, disabling fatigue, chest pain and episodes of near-fainting.
• Heart failure: Prolonged severe aortic stenosis can cause heart failure, which affects quality of life and can be life-threatening. Once the ventricle is permanently damaged, valve replacement may improve symptoms but cannot fully restore lost function.
• Higher procedural risk: Patients who present late, in decompensated heart failure or with kidney and liver involvement, generally face higher risk during any intervention, so timely referral matters.

Because of this, Apollo Hospitals Lucknow emphasises early echocardiographic diagnosis and prompt referral for valve assessment rather than watchful waiting once symptoms begin.

Benefits of TAVR Surgery

• Quicker return to routine: Many patients resume light daily activity within a few days because there is no breastbone incision to heal.
• Shorter hospital stay: Uncomplicated transfemoral cases are often discharged within 24 to 72 hours, though the actual stay depends on rhythm monitoring, kidney function and general recovery.
• Improved cardiac haemodynamics: Relieving the obstruction usually improves forward flow, reduces ventricular pressure and eases symptoms.
• Reassuring medium-term data: Randomised trials have followed TAVR patients for five years and beyond with durability and survival broadly comparable to surgery in the populations studied. Very long-term durability data, particularly in younger patients, are still accumulating, and this is discussed honestly during counselling.

Preparation and Recovery

Preparation tips

• Consultation: A comprehensive evaluation with the cardiology team to review symptoms, medical history and functional status.
• Preoperative testing: Echocardiography, CT aortography, coronary angiography, blood tests including kidney function, and other imaging as required.
• Medication management: Follow instructions carefully about blood thinners, antiplatelets, diabetes medicines and diuretics, some of which need adjusting before the procedure.
• Lifestyle adjustments: A heart-healthy, low-salt diet, stopping tobacco and gutka, and light activity as advised.

Recovery tips

• Follow-up appointments: Attend all scheduled reviews so valve function and heart rhythm can be monitored.
• Rest and activity: Balance rest with gentle walking, increasing gradually as advised.
• Watch for symptoms: Report groin swelling or bleeding, chest pain, fever, fainting, very slow pulse or sudden breathlessness immediately.
• Support system: Arrange for a family member to stay with you, especially in the first few days.

Timing of the Procedure and the Pre-Procedure Phase

TAVR is almost always a planned procedure. Between the first cardiology visit and the procedure date there is a work-up phase, usually a few days to two or three weeks, during which suitability is confirmed.

1. Confirming severity: Echocardiography measures valve area, mean gradient and jet velocity, and assesses ventricular function and other valves.
2. Anatomical planning: CT aortography measures the aortic annulus, root dimensions, coronary heights and the calibre and calcification of the femoral and iliac arteries, which determines valve size and access route.
3. Coronary assessment: Coronary angiography identifies blockages that may need stenting before or during the same admission.
4. General fitness: Kidney function, haemoglobin, sugar control, lung function, carotid status, dental review and a frailty assessment.
5. Heart Team decision: The team recommends TAVR, surgical valve replacement, or in some cases medical management and palliative care, and explains the reasoning to the family.

Patients in decompensated heart failure may be admitted earlier for stabilisation, and in rare unstable cases balloon aortic valvuloplasty is used as a bridge before definitive valve replacement.

What Current Guidelines Say

Decision-making at experienced Indian centres follows a combination of Indian and international guidance:

• The Cardiological Society of India (CSI) Position Statement on Transcatheter Aortic Valve Implantation in India (2022) sets out patient selection, institutional requirements, Heart Team composition, operator training and audit expectations for TAVI in the Indian setting, and highlights India-specific issues such as younger age at presentation, rheumatic and bicuspid valve disease, and cost.
• The 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease recommend intervention for symptomatic severe aortic stenosis, with the choice between TAVI and surgery based on age, surgical risk, anatomy and patient preference. In this guidance TAVI is generally favoured in older patients, broadly those aged 75 or above, or those at high surgical risk, while surgery is favoured in younger, lower-risk patients.
• The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease, with the 2023 focused update on atrial fibrillation-related aspects, takes a similar age- and risk-based approach, placing TAVR and surgery as reasonable alternatives in intermediate-risk patients aged roughly 65 to 80.

What changed recently: the most important shift over the last few years is that TAVR is no longer restricted to inoperable or high-risk patients. Trial evidence in low-risk patients has moved the recommendations towards a shared, age-based decision, and there is growing emphasis on lifetime management, that is, planning now for how a second valve procedure could be done later if the first valve degenerates. Guidelines also now stress that valve interventions should be done at centres with adequate volume and a formal Heart Team.

Guidance evolves, and the recommendation for any individual patient may differ from the general rule. Your Apollo cardiologist will explain how these principles apply to you.

TAVR Compared With Other Treatment Options

Valve platforms differ too. Balloon-expandable and self-expanding systems each have advantages depending on annulus size, calcium pattern, coronary height and whether future coronary access may be needed. The Heart Team selects the device; brand availability and pricing should be discussed at the time of planning.

Procedures Sometimes Done at the Same Time or Nearby

• Coronary angioplasty and stenting: Significant coronary blockages are often treated before or during the same admission.
• Permanent pacemaker implantation: Some patients develop conduction block after valve deployment and need a pacemaker, usually within the same admission.
• Peripheral artery treatment: Occasionally the iliac or femoral artery needs angioplasty to allow safe access.
• Left atrial appendage or mitral interventions: Considered in selected patients, though usually staged rather than done together.
• Dental clearance and treatment: Active dental infection is treated beforehand to reduce the risk of valve infection.
• Valve-in-valve TAVR: When a previously implanted surgical tissue valve has degenerated, a TAVR valve can sometimes be placed inside it.

Phase-by-Phase Recovery

Recovery is slower in patients who were frail before the procedure, who needed alternative access, or who developed complications. These timelines are typical, not guaranteed.

Returning to Normal Activity, Work and Indian Daily Routines

• Walking: Short indoor walks from day one at home, building up to 20 to 30 minutes of comfortable walking over four to six weeks.
• Stairs: Usually manageable within one to two weeks after transfemoral TAVR, taken slowly and with a handrail.
• Squatting and Indian-style toilets: Deep squatting strains the groin puncture site and is best avoided for about two to four weeks. Where possible use a Western commode or a commode chair placed over the Indian toilet during this period, and install a grab bar for elderly patients.
• Sitting cross-legged on the floor: Generally acceptable once the groin site is fully healed and painless, usually after two to three weeks, though older patients with stiff joints may find a chair easier.
• Floor sleeping: Getting up from the floor requires pushing through the arms and hips and can be tiring in the first two weeks. A cot or firm mattress at bed height is safer initially, particularly to reduce fall risk in the elderly.
• Bathing: Sponge bathing until the groin site is dry and sealed, then showers. Avoid bucket-squat bathing until squatting is permitted; use a bathing stool.
• Driving and two-wheelers: Usually not before two to four weeks, and later if a pacemaker was implanted. Pillion travel on Indian roads jolts the groin site and is best delayed.
• Work: Desk and supervisory work often resumes in two to four weeks. Manual labour, farming, loading and long-distance driving need individual clearance, often at six weeks or more.
• Lifting: Avoid lifting more than about 5 kg for the first two to four weeks, including water buckets, gas cylinders and grandchildren.
• Exercise and sport: Structured walking, stationary cycling and light yoga suit most patients. Competitive sport, heavy weight training and strenuous asanas involving breath-holding or straining need explicit clearance and, in younger patients, a formal exercise assessment.
• Religious and social life: Temple visits, prayer and family functions can usually resume within a few weeks. Long pilgrimages, fasting and crowded travel should be discussed at the follow-up visit, particularly for patients on blood thinners.

Protecting the New Valve and Preventing Problems

• Take antiplatelet or anticoagulant medicines exactly as prescribed, and never stop them on your own before dental or other procedures.
• Maintain excellent dental hygiene and have regular dental check-ups; tell every dentist and doctor that you have a prosthetic aortic valve, as antibiotic prophylaxis is recommended before certain dental procedures.
• Treat fever, skin infection, urinary infection and boils promptly, and do not ignore prolonged unexplained fever, which can signal valve infection.
• Avoid unregulated tattooing, ear or nose piercing and non-sterile procedures.
• Control blood pressure, diabetes, cholesterol and weight; stop smoking, tobacco chewing and alcohol.
• Reduce salt, papad, pickles, packaged namkeen and restaurant food if heart failure is present.
• Attend annual echocardiography even when you feel completely well, so valve degeneration is picked up early.
• Carry your valve implant card and discharge summary when you travel, and keep a photograph of them on your phone.

Older Adults, Younger Patients and Children

Older and frail adults

Most TAVR patients in India are over 70. Assessment includes frailty, memory, nutrition, anaemia, kidney function and fall risk. TAVR can relieve symptoms substantially in this group, but if severe dementia, advanced cancer or profound frailty means the patient is unlikely to benefit, the Heart Team will say so honestly and discuss symptom-focused care instead. Delirium prevention, careful contrast use and early mobilisation are part of the elderly pathway.

Younger and lower-risk adults

For patients in their forties, fifties and early sixties, surgical valve replacement often remains the preferred option because long-term durability of surgical valves is better established and lifetime planning matters. Bicuspid valves and post-rheumatic valves, both common in India, can have anatomy less favourable to TAVR. This is a shared decision that weighs durability, anticoagulation, occupation and family plans.

Children and congenital valve disease

TAVR as described here is a procedure for adult calcific aortic stenosis and is not used in children. Children and adolescents with aortic valve disease are managed by paediatric cardiology and paediatric cardiac surgery with balloon valvuloplasty, valve repair, the Ross procedure or surgical replacement, depending on the anatomy. Families should ask for referral to the paediatric cardiac team rather than the TAVR pathway.

Women, pregnancy and anticoagulation

Women of childbearing age with severe aortic stenosis need pre-pregnancy counselling, because valve choice affects anticoagulation safety in pregnancy. This requires a joint cardiology and obstetric discussion before any valve procedure.

If You Choose Not to Have the Procedure

Declining valve replacement is a legitimate choice, and it should be an informed one. Without intervention, severe symptomatic aortic stenosis generally progresses; historical series show high mortality within a few years of symptom onset, with the outlook worst once heart failure, fainting or angina appears. Medicines can reduce fluid overload and breathlessness but cannot relieve the mechanical obstruction, and some drugs must be used cautiously because a fixed narrowing limits the heart's ability to respond to falling blood pressure.

If you decide against TAVR or surgery, the team can still help with diuretic titration, anaemia and diabetes control, symptom-based activity advice, home-based support, and palliative care input where appropriate. You can change your mind, though the balance of risk and benefit may shift if the heart weakens further. Families should also discuss goals of care and hospital-admission preferences in advance.

Factors That Influence the Cost of TAVR

TAVR is one of the more expensive cardiac interventions in India, mainly because of the valve device itself. Apollo Hospitals Lucknow provides a written estimate after evaluation. The factors below explain why two patients can receive very different estimates.

Apollo Hospitals Lucknow does not publish a fixed TAVR price on this page, and figures quoted by third-party price websites are unreliable. Please ask the cardiac sciences desk or the billing and insurance desk for a current, itemised estimate before admission.

Insurance, Cashless Treatment and TPA Process in India

• Planned, not accident cover: Aortic stenosis is a disease, so TAVR is claimed under the illness or hospitalisation benefit of your policy, not under personal accident cover. Personal accident policies typically do not pay for degenerative valve disease.
• Waiting periods matter: Most Indian indemnity policies apply an initial waiting period of about 30 days, a specific-disease waiting period of one to two years for certain listed conditions, and a pre-existing disease waiting period that under current IRDAI norms may extend up to 36 months. If your valve disease was diagnosed or symptomatic before the policy started, disclose it and ask the insurer in writing whether it is payable.
• Sum insured versus device cost: Because the prosthesis is costly, a modest sum insured can be exhausted quickly. Check whether you have a top-up or super top-up, a corporate policy, or a second policy that can be used for the balance.
• Cashless pre-authorisation: For a planned procedure, submit documents to the TPA or insurer several days in advance. Approvals commonly take 24 to 72 working hours, and queries can extend this, so do not plan admission on the same day you apply.
• Documents usually required: policy copy and card, photo ID and Aadhaar, doctor's advice note with diagnosis, echocardiography and CT reports, past treatment records, and the hospital's estimate.
• Reimbursement route: If cashless is denied or your insurer is not empanelled, you can pay and claim later. Retain original bills, itemised device invoice with the valve sticker or implant sticker, discharge summary, all reports and payment receipts.
• Non-payable items: Consumables, gloves, some disposables, attendant food, telephone and comfort items are commonly excluded and payable by you. Room-rent capping and proportionate deduction clauses can also reduce settlement if you choose a higher room category than your policy allows.
• Government and employer schemes: Coverage under CGHS, ECHS, state government employee schemes, PSU schemes or Ayushman Bharat depends on empanelment and on whether the specific procedure and implant are listed. Confirm current status with the insurance desk before admission, as empanelment and package rules change.

Because policy terms, empanelment and package rates differ, please verify all coverage questions directly with the Apollo Hospitals Lucknow insurance and TPA desk rather than relying on general information.

Planning the Admission and What to Bring

Before you travel to the hospital

• Confirm the admission date, reporting time and fasting instructions.
• Complete insurance pre-authorisation and dental clearance if advised.
• Clarify which medicines to stop and when, especially blood thinners, metformin and SGLT2 inhibitors.
• Arrange one primary attendant plus a backup; in joint families, decide who will handle billing, who will stay overnight and who will manage home and children, and give the treating team one contact number to avoid confusion.

What to pack

• All previous prescriptions, discharge summaries, ECGs, echo and CT reports on paper and, if possible, on a CD or pen drive
• Current medicine strips in their original packing
• Aadhaar or photo ID, insurance card, policy documents, employer or scheme letters
• Loose front-open clothing, non-slip slippers, spectacles, hearing aid and denture case
• Toiletries, a light towel, mug, and adult diapers or pads if incontinence is an issue
• Phone with charger and a long cable, a small notebook for instructions
• Modest cash and a functioning debit or credit card for non-payable items

What to leave at home

• Jewellery, large sums of cash and valuables
• Home-cooked food unless the dietician has approved it, since salt and fluid limits apply after valve procedures

Preparing the house before discharge

• Place a bed or cot at comfortable height on the ground floor if possible
• Arrange a commode chair or Western toilet access and a bathroom stool
• Clear loose wires, mats and slippery floors to prevent falls
• Keep a pill organiser, BP monitor, weighing scale and thermometer at hand

Warning Signs That Need Urgent Review

Contact the cardiac team or reach the nearest emergency department immediately if you notice:

• Sudden severe breathlessness, or breathlessness on lying flat
• Chest pain or pressure lasting more than a few minutes
• Fainting, blackouts, or a pulse persistently below about 45 beats per minute
• New palpitations, especially if fast and irregular
• Weakness or numbness of the face, arm or leg, slurred speech or sudden loss of vision, which may indicate stroke
• Expanding swelling, a painful lump, or fresh bleeding at the groin puncture site
• A cold, pale or painful leg on the side of the puncture
• Fever above 100.4?F persisting beyond a day or two, chills, or night sweats
• Rapid weight gain of 2 kg or more in three days, or increasing leg and abdominal swelling
• Black stools, blood in urine or unusual bruising while on blood thinners

For Patients Travelling from Nearby Districts and Cities

Apollo Hospitals Lucknow serves patients from across Uttar Pradesh and neighbouring states, including Kanpur, Unnao, Barabanki, Sitapur, Hardoi, Lakhimpur Kheri, Rae Bareli, Sultanpur, Amethi, Ayodhya, Basti, Gonda, Bahraich, Balrampur, Shravasti, Pratapgarh, Jaunpur, Varanasi, Prayagraj, Gorakhpur, Bareilly, Shahjahanpur, Farrukhabad, Kannauj, Fatehpur, Banda, Chitrakoot and Jhansi, as well as from parts of Bihar, Nepal and Uttarakhand.

Practical tips for outstation families