NE HEALTH BUREAU
CHENNAI, JAN 22
In a landmark achievement for global cardiovascular medicine, Kauvery Hospital, Alwarpet has successfully performed one of the world’s first highly complex TAVR-in-TAVR-in-SAVR procedures, combined with bioprosthetic valve fracture and dual cerebral protection, on a 78-year-old man with repeatedly failing aortic valves. The rare and technically demanding intervention marks a significant milestone in the management of advanced structural heart disease.
- A Global First in Heart Care: Rare triple-layer valve intervention redefines possibilities in structural cardiology
- When Two Valves Fail: A 78-year-old patient’s complex journey from surgery to transcatheter innovation
- Precision Under Pressure: Bioprosthetic valve fracture enables optimal expansion and flow
- Protecting the Brain: Dual cerebral protection minimises stroke risk in a high-stakes procedure
- World-Class Care at Home: Chennai emerges as a destination for advanced cardiac innovation
The patient’s long and challenging medical history dates back to 2005, when he was diagnosed with severe aortic stenosis, a life-threatening condition caused by narrowing of the heart’s main valve. He underwent Surgical Aortic Valve Replacement (SAVR) with a bioprosthetic tissue valve. Over time, this valve degenerated, and in 2019, he was treated with a Transcatheter Aortic Valve Replacement (TAVR)—a minimally invasive valve-in-valve procedure that avoided repeat open-heart surgery.
In subsequent years, the patient again developed breathlessness and fatigue. Investigations revealed rising pressure gradients across the valve, indicating renewed obstruction to blood flow. Detailed evaluation showed leaflet thrombosis, where blood clots caused thickening of the valve leaflets, preventing them from opening fully. Although anticoagulation temporarily improved valve function, the problem recurred whenever treatment was stopped, leading to early degeneration of the transcatheter heart valve.
Given his advanced age, multiple prior valve procedures and high surgical risk, repeat open-heart surgery was deemed hazardous.
After referral to Kauvery Hospital, Alwarpet, a multidisciplinary Heart Valve Team led by Dr. Rajaram Anantharaman and Dr. C. Sundar conducted an exhaustive evaluation using advanced 3D echocardiography and CT imaging. The investigations confirmed persistent leaflet thickening and restricted valve motion due to under-expansion of the previously implanted TAVR, resulting in abnormal leaflet movement or “pin-wheeling.”
Following meticulous planning, the team opted for a TAVR-in-TAVR-in-SAVR approach—implanting a new transcatheter valve inside the failed transcatheter valve, which itself was inside the original surgical valve.
To optimise valve expansion and restore effective blood flow, the team employed a bioprosthetic valve fracture technique, involving controlled high-pressure expansion to fracture the rigid frame of the original surgical valve. This created additional space, allowing the newly implanted valve to expand fully and function optimally.
Given the high neurological (stroke) risk associated with such a complex intervention, dual cerebral protection was deployed using two Spider FX devices placed in both carotid arteries supplying the brain. These devices captured embolic debris during the procedure, significantly reducing the risk of stroke.
The challenge was further amplified by the patient’s bicuspid aortic valve anatomy, associated aortopathy with a moderately dilated aorta, and pseudo-coarctation of the thoracic aorta, marked by narrowing and tortuosity—alongside the failure of both a prior surgical and transcatheter valve.
Speaking about the achievement, Dr. Rajaram Anantharaman, Director for Transcatheter Heart Valve Therapies, Kauvery Hospital, Chennai, said, “The challenging procedure needed meticulous planning and precision by the Heart Valve Team. Despite these complexities, the procedure was successfully completed. The patient showed rapid recovery, was shifted to the ward the next day, and discharged within 48 hours. Post-procedure assessments confirmed excellent valve function, stable neurological status, absence of major complications, and full mobility.”
Commenting on the global significance of the case, Dr. Aravindan Selvaraj, Co-Founder and Executive Director, Kauvery Group of Hospitals, said, “This case reflects the depth of clinical expertise available at Kauvery Hospital, Alwarpet. Managing such high-risk and complex structural heart cases locally reduces the need for patients to seek care abroad and reinforces Chennai’s growing role as a centre for advanced cardiac interventions.”
With this path-breaking feat, Kauvery Hospital, Chennai, continues to strengthen its leadership in structural heart disease management, leveraging cutting-edge transcatheter technologies, advanced imaging and comprehensive multidisciplinary cardiac care—bringing world-first innovations closer to patients’ homes.
