This is a first-of-its-kind procedure performed in India. A valve in valve replacement is done when a previously implanted surgical valve is degenerated or re-narrowed over a period of time.

The procedure through a transcatheter is a recent advancement, which has been approved for high-risk patients initially. A hybrid cath lab operating room is the safest place to perform this high risk and complex procedure.

A hospital in Chennai, on June 2 announced the successful treatment of an 82-year-old man with multiple heart valve diseases. The procedure which is a first of its kind in the country involved two-valve in valve replacement using a transcatheter and a pacemaker was also implanted through a transcatheter in the same procedure to resolve slow heart rate.

The patient, aged 82, from Coimbatore, suffered from multiple heart valve diseases which included a severe aortic valve leak, mitral valve leak and moderately leaking tricuspid valve with severe pulmonary hypertension, (high pressure in the arteries of lungs and right side of heart).

Also known as the leaky valve disease, the condition is when the heart valve does not close properly, causing leakage in the blood flow, pushing the heart to strain further for effective pumping of the blood which would eventually lead to a heart failure or cardiac arrest.

Speaking on the condition, Dr R. Anantharaman, senior consultant, interventional cardiologist at the hospital said, The man had a history of severe regurgitation (leak) of both mitral and aortic valve and the tricuspid valve which leaked moderately.

In 2012, he went through a valve replacement surgery where the aortic valve was replaced with a 21 mm bioprosthetic valve, the mitral valve was replaced with a 31 mm bioprosthetic valve and the tricuspid valve was repaired. A bypass graft to the front of the left anterior descending artery was also performed on him. At this point, the functioning of his heart had significantly reduced and post-surgery, he was sustained medical treatment.

Fast forward to this year, he started to face difficulties in breathing and it worsened over a period of 4 to 6 months, to an extent where he was unable to walk or lie flat on his back. Our team examined his condition and his medical history, where the ECHO (Echocardiography) showed a re-narrowing in the aortic and mitral bioprosthetic valves.

Considering his age, reduced heart function and the previous surgery we could not afford a repetition of the same surgery, due to the high risks involved. After a thorough heart team discussion, we performed valve in valve replacement using a transcatheter (minimally invasive) for both the aortic and mitral valves, which appeared to be the ideal solution. Additionally, we also detected a conduction block in his heart which was resolved by a pacemaker, using a transcatheter pacemaker (Micra), adds Dr Anantharaman.

A transcatheter procedure for a valve in valve replacement is recommended for those who had undergone open-heart surgeries with a tissue valve, which is failing now and the recovery period in this is faster when compared to surgery. In this case, the individual was discharged on the 3rd-day post-procedure and is doing fairly well.

Speaking on the success of the treatment, Dr Aravindan Selvaraj, Co-founder & Executive Director of the hospital said, "The valve in valve replacement through a transcatheter has been adopted significantly in the west, and it is proved to be safer for high-risk patients who had already undergone open-heart surgery."

"However transcatheter procedures do come with a lot of other risks and complications, which can be handled only by an expert team and the right infrastructure. The procedure was performed in the safest place, which is the Hybrid Cath Lab Operating Room under the expertise of the cardiologist and his skilled team. I would like to appreciate our interventional cardiologist, Dr. Anantharaman and team for their remarkable efforts to improve the quality of life."