4 min readUpdated: Aug 5, 2026 01:01 PM IST
For 39 years, a Delhi man lived with a heart that was not only on the right side of his chest but was also wired differently from birth. He did not know that one side of his heart was doing a job it was never designed to do — pumping blood to the entire body instead of just the lungs. Over time, that extra strain weakened his heart and damaged one of its valves, leaving him in need of a complex operation.
Last month, doctors at VMMC & Safdarjung Hospital performed what they say is the world’s first robotic replacement of this damaged heart valve in a patient with an unusual heart anatomy. Instead of opening his chest through the breastbone, the surgical team carried out the operation through a small incision using a robotic system, making it the world’s first robotic valve replacement in a patient whose heart anatomy was essentially a mirror image of normal.
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Born with two rare heart defects
The patient was born with two rare heart defects. One, called dextrocardia, meant his heart developed on the right side of his chest instead of the left. The second, congenitally corrected transposition of the great arteries (ccTGA), meant the heart’s pumping chambers were connected differently, forcing the right ventricle (lower heart chamber) to do the left ventricle’s job.
Why the heart eventually began to fail
To explain why this mattered, Dr Anubhav Gupta, professor and HOD, Department of Cardiothoracic and Vascular Surgery (CTVS), says normally, the right side of the heart pumps blood to the lungs, while the stronger left side pumps oxygen-rich blood to the rest of the body. In this patient, those roles were reversed. “The right ventricle, which is naturally built to pump blood only to the lungs under low pressure, had spent nearly four decades pumping blood to the entire body. Over time, that constant workload caused it to weaken,” he says.
The problem was made worse because the damaged tricuspid valve — normally found on the right side of the heart — was functioning as the body’s main pumping valve. As the overworked right ventricle weakened over the years, the valve also began to fail, eventually requiring replacement.
“These are birth defects that often remain silent for decades,” says Dr Gupta. “Patients may not develop symptoms until adulthood, once the mismatched ventricle can no longer keep compensating,” he adds.
While similar cases have been reported in medical literature, he says the only published report of this combination being treated surgically dates back to 2011 and involved conventional open-heart surgery. That meant the Safdarjung team had no roadmap to follow.
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Reversing the surgery
Before the operation, the doctors created a three-dimensional reconstruction of the patient’s heart using CT scans.
Because the patient’s heart was reversed, surgeons had to reverse their own approach. A procedure normally performed from the patient’s right side had to be carried out from the left, requiring the robotic ports, instruments and operating strategy to be completely redesigned.
“We mirrored the whole operation. Everything — the ports, the instruments and our surgical approach — had to be redesigned to match the patient’s anatomy,” says Dr Gupta.
The team spent four days planning the operation before performing the robotic procedure, which lasted about three to four hours. Unlike conventional open-heart surgery, which requires splitting the breastbone and temporarily stopping the heart while a heart-lung machine takes over circulation, the robotic procedure was performed through a single incision of about three centimetres.
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A new roadmap for rare heart defects
The patient did not require a sternum incision or rib spreading and was discharged within a few days. Dr Gupta says the operation demonstrates that even highly complex congenital heart defects can be managed through minimally invasive robotic techniques. “This can now be done at other centres too. Surgeons will now have a mirrored, left-sided approach they can follow for similar anatomy, rather than starting from scratch as we had to,” adds Dr Gupta.
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