1 September, 2025

Bicuspid TAVR (TAVI) in India: A Patient’s Complete Guide

Why this matters

If you or a loved one has been told you have a bicuspid aortic valve (BAV) and now need treatment for aortic stenosis, you’ve probably come across the term TAVR (Transcatheter Aortic Valve Replacement, also called TAVI).

In India, TAVR is no longer limited to a few metro hospitals—it’s becoming available at specialized heart centers across Delhi, Chennai, Bengaluru, Hyderabad, and Mumbai. But when the valve is bicuspid, the decision is a little more complex. Let’s break it down in a way that’s clear, practical, and India-focused.

What exactly is a bicuspid aortic valve?

Normally, the aortic valve has three thin leaflets.
In BAV, you’re born with two—often fused with a ridge called a raphe.
This valve tends to wear out earlier, leading to narrowing (stenosis) or sometimes leaking.
Many Indians discover BAV only in their 40s, 50s, or 60s—often when symptoms like breathlessness, chest pain, or fainting appear.

Why bicuspid valves make TAVR special

TAVR was perfected in tricuspid valves first. But bicuspid anatomy brings challenges:

The valve opening is usually oval, not round.
Leaflets are bulkier and heavily calcified.
A calcified raphe can increase the risk of complications if not handled carefully.

This is why CT scans and Heart-Team planning are so critical before TAVR in BAV patients.

Who is an ideal candidate for bicuspid TAVR in India?

It depends on:
✅ Age & surgical risk – Older patients or those unfit for open-heart surgery are stronger candidates.
✅ CT anatomy – If your valve has heavy calcium or a very calcified raphe, the team may lean toward surgery.
✅ Other conditions – A dilated ascending aorta may require surgery instead of TAVR.

Guideline takeaway: In the 65–80 age group, both TAVR and surgery can be options—final choice should always come from a Heart-Team discussion.

How doctors plan the procedure

Before TAVR, you’ll undergo:

Echocardiogram – to confirm severity.
CT Angiography (CTA) – the most important scan; it measures annulus size, coronary heights, and calcium burden.
Angiogram – to check coronary arteries.
Blood work & frailty tests – to prepare for anesthesia and recovery.

Step-by-step: How bicuspid TAVR is done

Access – usually through the femoral artery in the groin.
Valve crossing & positioning – a thin catheter is guided to the aortic valve.
Deployment – a new tissue valve mounted on a stent is expanded inside the old valve.
Check & adjust – doctors may do a gentle balloon expansion if needed.
Recovery – most patients are up and walking in 24–48 hours.

Valves used in India

Edwards SAPIEN (balloon-expandable, imported)
Medtronic Evolut (self-expanding, imported)
Myval (Meril Life Sciences, India-made) – increasingly popular because it’s cost-effective and CE-approved.

Fun fact: India is home to one of the world’s leading home-grown TAVR valves (Myval), already used successfully in bicuspid patients!

What are the risks?

Paravalvular leak (gap around valve) – more likely in BAV.
Root injury or rupture – rare but more common with calcified raphe.
Pacemaker requirement – sometimes needed if the valve affects heart’s conduction.
Stroke or vascular injury – uncommon, but embolic protection may be used.

How successful is bicuspid TAVR?

Latest studies show:

Excellent short- and mid-term outcomes in well-selected BAV patients.
In India too, results are matching global standards when done at high-volume centers.
Success depends more on anatomy and team expertise than on whether the valve is bicuspid or tricuspid.

TAVR vs Surgery in bicuspid valves

Surgery (SAVR): still gold standard for younger patients (<60) or those with aortic dilation.
TAVR: minimally invasive, faster recovery, excellent choice for older/high-risk patients.

Recovery after TAVR in India

Hospital stay: 2–3 days (sometimes even next-day discharge).
Return to work/light activity: within 1–2 weeks.
Follow-ups: echo at 30 days, 6 months, then yearly.
Medications: usually antiplatelets like aspirin ± clopidogrel.

Cost of TAVR in India

This is a common and important question.

Typical range: ₹18 – 30 lakh.
Costs depend on city, hospital, and valve choice (imported vs India-made).
Delhi, Chennai, Hyderabad, Bengaluru, Mumbai are major hubs offering TAVR.

Tip: Always ask for a package estimate—covering device, procedure, ICU, and follow-up.

Choosing the right hospital in India

Look for:

A Heart-Team program (cardiologists + surgeons + imaging specialists).
Experience in bicuspid TAVR cases.
Multiple valve options (so you’re not limited to one).
Transparent costs & rehab support.

FAQs on Bicuspid TAVR in India

1. Is TAVR safe for bicuspid valves?
Yes, but only in carefully selected patients. Anatomy plays a big role.

2. Which valve is best for me?
Both balloon-expandable and self-expanding valves are used. Your CT scan decides which is safest.

3. Will I need a pacemaker?
Some patients do, especially with self-expanding valves. But doctors take steps to minimize this risk.

4. How long does the valve last?
Durability beyond 8–10 years is still being studied, especially in younger BAV patients.

5. Can TAVR treat my enlarged aorta too?
No—if the aorta is dilated, surgery may be better.

6. What’s the cost in India?
Usually ₹18–30 lakh, depending on hospital and device.

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