A team of cardiac specialists at Kauvery Hospital, Alwarpet, has reported what is believed to be the world’s first successful fully catheter-based replacement of two failed heart valves in a patient who had previously undergone a Ross procedure. The minimally invasive treatment was performed without reopening the chest, offering a potential alternative for selected high-risk patients who are unsuitable for repeat open-heart surgery.
The recipient, a 58-year-old man, had undergone a Ross procedure nearly 25 years ago. In this complex operation, the patient’s pulmonary valve is used to replace the diseased aortic valve, while the pulmonary valve itself is replaced with a donor human valve. Although the procedure delivers excellent long-term outcomes, both valves can deteriorate over time and may eventually require further treatment.
Years after the surgery, the patient developed severe dysfunction in both replacement valves. Doctors diagnosed severe leakage of the aortic and pulmonary valves, moderate pulmonary stenosis, severe pulmonary hypertension, and moderate mitral valve regurgitation. His condition led to repeated episodes of heart failure, causing severe breathlessness, swelling of the legs and abdomen, reduced kidney and liver function, and difficulty sleeping. He had progressed to New York Heart Association (NYHA) Class III-IV heart failure.
Because of the complexity of a second open-heart operation, several hospitals considered conventional surgery too risky. A minimally invasive solution was also regarded as technically demanding due to the patient’s anatomy and the condition of both failing valves.
After conducting detailed three-dimensional echocardiography and cardiac CT imaging, the multidisciplinary team at Kauvery Heart Institute explored the possibility of treating both valves through a completely catheter-based procedure. As the team found no previously published medical report describing an identical approach, the treatment plan underwent extensive review by specialists led by Dr. Rajaram Anantharaman, along with an international panel of experts, before the intervention was approved.
The procedure was carried out in a hybrid catheterisation laboratory under general anaesthesia with continuous transoesophageal echocardiography guidance. Doctors first reconstructed the failing pulmonary homograft using covered stents and balloon dilatation before implanting a Medtronic Melody transcatheter pulmonary valve. They then replaced the failing aortic autograft with an Edwards Sapien 3 Ultra Resilia balloon-expandable valve. Since the diseased aortic valve lacked sufficient calcium to anchor the new valve, the team relied on advanced procedural planning, including AI-based predictive modelling and virtual valve implantation, to achieve accurate placement.
The patient’s recovery was smooth, requiring only a short stay in the intensive care unit before discharge. At a follow-up visit two weeks later, his symptoms had improved significantly. The swelling had resolved completely, he was able to sleep comfortably, had returned to NYHA Class I functional status, and could walk continuously for 20 to 30 minutes without 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.”
Conclusion
The successful treatment represents a significant milestone in interventional cardiology and highlights the growing role of advanced catheter-based therapies in managing complex structural heart disease. If validated through future clinical experience and published evidence, the approach could expand treatment options for carefully selected patients facing high surgical risk after previous Ross procedures.
(Photo credit: kauveryhospital.com)