failing Aortic and Pulmonary Valve

Kauvery Hospital, Alwarpet, has successfully treated two failing heart valves in a patient without repeat open-heart surgery, in what is believed to be the world's first reported completely catheter-based treatment following a Ross procedure. The procedure was performed on a 58-year-old man who had undergone a complex heart valve operation nearly 25 years ago. He had previously undergone the Ross procedure, in which the patient's own pulmonary valve is moved to replace the diseased aortic valve (known as an aortic autograft), while the pulmonary valve is replaced with a donated human valve (known as a pulmonary homograft). Although the Ross procedure provides excellent long-term outcomes, both valves can deteriorate over time and may require further intervention. The patient presented with severe aortic regurgitation, severe pulmonary regurgitation with moderate pulmonary stenosis, severe pulmonary hypertension and moderate mitral regurgitation. He had repeated admissions for heart failure with severe swelling of the legs and abdomen, impaired kidney and liver function, and severe breathlessness. He was unable to sleep comfortably and was in New York Heart Association Class III–IV heart failure. He had consulted multiple centres where repeat open-heart surgery was considered prohibitively high risk because of the complexity of a second operation. Even a catheter-based approach was considered extremely challenging. Following a detailed evaluation using three-dimensional echocardiography and cardiac CT imaging, the multidisciplinary heart team at Kauvery Heart Institute identified the possibility of treating both failing valves through a completely catheter-based approach without repeat open-heart surgery. Since no similar case had been reported in the published medical literature, the treatment strategy was reviewed extensively by the hospital's heart team led by Dr Rajaram Anantharaman, Director of Transcatheter Heart Valve Therapies and an international panel of experts before proceeding. The pulmonary homograft was initially prepared by placing covered stents, followed by balloon dilatation, before implanting a Medtronic Melody transcatheter pulmonary valve. The failing aortic autograft was then treated with an Edwards Sapien 3 Ultra Resilia balloon-expandable valve. As there was no calcium within the valve to help anchor the replacement valve, the procedure required meticulous planning and precise execution, with AI predictive modeling with virtual Valve implant. It was performed in a hybrid operating room under general anaesthesia with continuous transoesophageal echocardiography guidance. The patient made an uneventful recovery and was discharged after a short stay in the intensive care unit. At his two-week follow-up, his symptoms had improved markedly. The swelling had completely resolved, he had returned to New York Heart Association Class I functional status, was sleeping comfortably, and was able to walk for 20–30 minutes without any limitation. Dr. Rajaram Anantharaman, Director for Transcatheter Heart Valve Therapies Kauvery Heart Institute, Alwarpet, said: "Patients with failure of both the aortic autograft and pulmonary homograft after a Ross procedure have very limited treatment options because repeat surgery carries considerable risk. Careful imaging, meticulous procedural planning and close collaboration across multiple specialties enabled us to successfully replace both valves using a catheter-based approach without reopening the chest. To the best of our knowledge, this is the first reported case of a completely percutaneous double transcatheter Ross rescue strategy in the published world literature. This case opens the possibility of treating carefully selected high-risk patients who otherwise may not have a viable treatment option." Dr. Aravindan Selvaraj, Co-founder and Executive Director, Kauvery Group of Hospitals, added: "Advanced structural heart interventions are transforming the way complex valve diseases are treated. Performing a procedure of this complexity requires experienced clinical teams, advanced imaging, hybrid operating room facilities and seamless coordination across specialties. This achievement reflects the advanced expertise and infrastructure available at Kauvery Heart Institute and our continued commitment to bringing the latest evidence-based treatment options to patients in India."