PGI Chandigarh becomes first hospital in north India to perform minimally invasive heart valve replacement

TMVR is a minimally invasive but technically challenging procedure to replace a mitral valve without conventional open-heart surgery. It is indicated to treat selected cases of narrowed mitral valve (mitral valve stenosis), leaky mitral valve (mitral valve regurgitation), or a mix of the two, especially in high surgical risk patients with failure of a previously implanted bioprosthetic heart valve.

Dr Otaal, who recently returned after completing a fellowship in transcatheter heart valve operations at the Liverpool Heart and Chest Hospital in the United Kingdom, told The Indian Express that the patient is a 78-year-old male who underwent bypass surgery along with mitral valve replacement in 2005. He also suffers from hypertension, kidney problems and low platelet count (thrombocytopenia).

“He began experiencing breathlessness over the last few months and was admitted with heart failure. He was diagnosed with structural degeneration of the previously implanted bioprosthetic surgical valve, leading to leakage as well as blockage, for which reintervention was mandatory,” the doctor said. Being at very high risk for conventional redo valve surgery, TMVR offered a minimally invasive alternative for valve replacement at very low risk.

Dr Otaal said the transfemoral transseptal access procedure was performed through the femoral vein on the leg which is the least invasive of all the implantation methods. After achieving femoral vein access non-surgically, the remainder of the procedure was performed under fluoroscopic (X-ray) and echocardiographic (ultrasound) guidance via transseptal route and a USFDA-approved Edwards Sapiens valve was implanted inside the failed surgical mitral valve.

“No open surgical access through the chest was required for the procedure and the patient completely recovered within a few hours of the procedure. This innovative technology shows promise for our patients with advanced mitral valve disease, especially those at high surgical risk,” said Dr Otaal.

The professor of cardiology, who primarily performed the procedure, was assisted by a team including a supporting cardiologist, cardiac anesthetists, perioperative imaging specialist, technical and nursing professionals. Surgical backup was provided by a cardiac surgical team, led by Dr Anand Misra.

Dr Rajarajan, associate professor of cardiac anesthesia, who additionally performed intraoperative trans-oesophageal imaging, added that the efforts of the various members of the team allow them to offer therapies such as this valve-in-valve procedure to patients who have no other options.