Medical History Record – Chennaionline

In a historic achievement, Kauvery Hospital, Chennai, has successfully performed the world’s first transcatheter mitral valve replacement (TMVR) with an extended external wrap and atrialized implant through femoral vein (groin) access on an 83-year-old patient who had been considered “inoperable” by multiple cardiac surgeons. The patient had multiple comorbidities and had recurrent hospital admissions due to heart failure caused by severe Mitral Valve dysfunction caused by severe Mitral Annular Calcification (MAC). As she had undergone radiotherapy to the chest twice in the past – first for cancer of the esophagus, and later following breast cancer surgery, any form of open-heart surgery or even minimally invasive surgical approaches was deemed too dangerous. Several cardiothoracic surgeons in India across major centers had declined surgery, leaving the patient without options. Severe Mitral Annular Calcification (MAC) – is a condition where heavy calcium deposits build up around the mitral valve of the heart. The mitral valve works like a door that opens and closes to regulate blood flow from left upper chamber (atrium) to lower chamber (ventricle). In MAC, this “doorframe” becomes rock-hard, jammed with calcium, making the valve unable to function properly. Patients develop severe breathlessness, fatigue, and heart failure. Surgery is usually very risky because stitching a new valve into this calcified ring can cause cracks, bleeding, or failure of the new valve. Standard catheter-based methods are also unsafe because the valve cannot be securely anchored. “To overcome these challenges, we developed a first-of-its-kind trans-catheter technique. A replacement valve was modified with an external wrap to ensure secure fixation and prevent leaks. It was then implanted in a slightly higher-than-usual position (atrialized implant) for proper anchoring, preventing leak around valve and preventing obstruction to left ventricular outflow tract (LVOT). Previously reported procedures were completed through ope heart surgery, with direct implantation through left atrium. Most importantly in this case, the entire procedure was completed through the right femoral vein in the groin, avoiding the need to open the chest. Patient recovered well from the procedure and was discharged home after a week. This is the world’s first case of its kind and it gives new hope to similar high-risk patients globally,” said Dr Rajaram Anantharaman, Senior Interventional Cardiologist at Kauvery hospital Alwarpet, Chennai. Dr. Aravindan Selvaraj, Co-founder & Executive Director, Kauvery Hospital, added, “This milestone is a testament to innovation, courage, and teamwork. To perform such a complex, first-in-the-world procedure on an elderly patient who was otherwise without options reflects our mission — to bring world-class, life-saving care to those who need it most. With this success, India has once again proven its place at the forefront of global medical excellence.” The woman has made a good recovery and is under regular follow-up care. This achievement serves as a “proof of concept” that can now be adopted worldwide for patients with similar high-risk profiles.