THEBUSINESSBYTES BUREAU

CHENNAI, JULY 11, 2026

In a landmark achievement in structural heart care, Kauvery Hospital, Alwarpet, has successfully performed what is believed to be the world's first completely catheter-based treatment to replace two failing heart valves in a patient who had previously undergone a Ross procedure — eliminating the need for a repeat open-heart surgery.

The groundbreaking procedure, described as a "Post ROSS Double Valve Rescue," was carried out on a 58-year-old man whose two heart valves had deteriorated nearly 25 years after undergoing the complex Ross procedure, in which a patient's own pulmonary valve is used to replace a diseased aortic valve while the pulmonary valve is replaced with a donor valve.

The patient was admitted with multiple life-threatening complications, including severe aortic and pulmonary valve failure, pulmonary hypertension, moderate mitral regurgitation, recurrent heart failure, impaired kidney and liver function, severe swelling, and debilitating breathlessness. He was classified as being in New York Heart Association (NYHA) Class III–IV heart failure.

Several hospitals had deemed repeat open-heart surgery too risky due to the complexity of a second operation, while even catheter-based treatment was considered extremely challenging.

After an extensive evaluation using advanced three-dimensional echocardiography and cardiac CT imaging, the multidisciplinary team at Kauvery Heart Institute developed a pioneering treatment strategy. As no similar case had been documented in published medical literature, the proposed approach underwent detailed review by the hospital's heart team, led by Dr. Rajaram Anantharaman, along with an international panel of experts.

The procedure involved preparing the failing pulmonary homograft with covered stents and balloon dilatation before implanting a Medtronic Melody transcatheter pulmonary valve. The diseased aortic autograft was subsequently treated using an Edwards Sapien 3 Ultra Resilia balloon-expandable valve. Since the damaged valve lacked calcium required for anchoring the replacement valve, the intervention demanded meticulous planning, AI-based predictive modelling with virtual valve implantation, and precision execution in a hybrid operating room under general anaesthesia with continuous transoesophageal echocardiography guidance.

The patient recovered without complications and was discharged after a brief stay in the intensive care unit. At his two-week follow-up, he showed remarkable improvement. His swelling had completely resolved, he returned to NYHA Class I functional status, was sleeping comfortably, and was able to walk for 20–30 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."

The successful intervention marks a significant milestone in interventional cardiology and offers fresh hope for high-risk patients with complex valve failures who may otherwise have limited or no surgical options.