India’s First Right Shoulder-Artery Heart Valve Replacement

In a first in India, SRM Prime Hospital performed an Alternate Access Transcatheter Aortic Valve Replacement/Implantation (TAVR/TAVI), a minimally invasive heart valve replacement procedure, through the artery under the right shoulder (right axillary artery), instead of the standard leg artery route, to save a 73-year-old patient with calcific severe aortic stenosis, a condition in which the heart valve narrows due to calcium deposits, restricting blood flow from the heart to the body. The patient, a retired professional, was discharged the third day after the procedure, and is now able to resume normal daily activities as before. TAVR/TAVI procedure is used to replace a diseased aortic valve without the need for open-heart surgery. Doctors deliver an artificial valve through a thin tube inserted into a blood vessel (artery) and position it within the narrowed valve to restore normal blood flow. The most common route is through the artery in the leg. However, in this patient, all conventional access routes proved to be unsuitable due to vascular limitations such as narrowing, blockages, or unfavorable anatomy of the blood vessels. As a result, doctors opted for the right axillary artery. The Procedure was led by Dr. Balamurugan S, Consultant – Interventional Cardiology and supported by Dr. A. Thomas George, Senior Consultant - Internal Medicine & Diabetology, Dr. P Balasubramanian, Senior Consultant - Cardiothoracic and Vascular Surgery, Dr. A. B. Gopalamurugan, Procedure Proctor, Cardiac Anesthetists and Critical Care Intensivist. In his comments Dr. Balamurugan, said, “The patient exhibited features of decompensated heart failure, where the heart is unable to pump effectively. Our evaluation confirmed calcific severe aortic stenosis, a narrowing of the aortic valve caused by calcium deposits that restrict blood flow. Given his age and condition, we opted for TAVR/TAVI; however, none of the standard access routes such as femoral, transcarotid, transcaval or Left subclavian, were feasible. The only viable option was the right axillary artery. We therefore performed this entirely percutaneous right trans-axillary TAVR, an India-first, using an advanced catheter-based valve delivery system.” He further added, “Modern treatments like TAVR provide safe and minimally invasive options, as there is less surgical trauma and faster recovery options, especially for elderly patients or those at high risk for open-heart surgery. In this case, it required advanced pre-procedure planning and precise catheter manipulation due to the tortuous course of the artery, along with expertise in alternative vascular access techniques. We are happy that our team, with utmost dedication to the quality outcome, performed the first of the kind procedure in India, and saved the senior citizen’s life.” In his comments Dr. A. Thomas George said, “Patients undergoing advanced procedures like TAVR are often elderly and have multiple underlying health conditions that need careful medical management. Our focus is on optimising these conditions and ensuring the patient remains stable throughout the treatment journey.” Aortic stenosis is primarily a disease of the elderly, with an incidence of about 2-7% in people above 65 years. It is usually caused by age-related valve degeneration and can also occur in conditions like chronic kidney disease. While age-related degeneration cannot always be prevented, risk can be reduced by controlling blood pressure and managing cholesterol. Regular cardiac check-ups, especially after age 60, is important. People should not ignore early warning signs such as fatigue during mild exertion, breathlessness, chest discomfort, and fainting spells. These symptoms may indicate serious valve disease. Early diagnosis allows timely treatment and helps prevent complications such as heart failure and sudden cardiac death.