Current status of transcatheter aortic valve replacement in India.

Transcatheter aortic valve replacement (TAVR) has proven to be the cornerstone therapy for patients with severe aortic stenosis (AS). India is currently overburdened with AS, both rheumatic and non-rheumatic. Although TAVR has revolutionized the treatment of non-rheumatic AS it does offer a ray of hope for rheumatic AS in future. It is difficult to measure the actual burden of AS in India due to lack of epidemiological studies in this population. Variable estimates have been given indicating a large number of patients eligible for TAVR. Despite its enormous potential, TAVR is still beyond the reach of an average Indian citizen. The progress for TAVR in India remains rather slow with obstacles at multiple levels. These include high costs, lack of coverage by insurance companies, continuous ignorance in government policies, lack of sufficient trained TAVR performing operators and lack of healthcare providers trained in post-TAVR care. Additionally, unique anatomical factors such as smaller body surface area, smaller annulus size, low coronary ostia take-off, smaller calibre of iliac and common femoral arteries pose unique challenges in terms of need for smaller hardware and increased chances of complications. It is crucial that the policy makers and healthcare personnel wake up to the benefits of this innovation and take appropriate steps to ease the dissemination of TAVR across the country.