Overview
Kauvery Hospital, Alwarpet, Chennai performed what is believed to be the world’s first completely catheter‑based rescue of both failing heart valves in a 58‑year‑old man who had undergone a Ross procedure nearly 25 years earlier. The patient presented with severe aortic regurgitation, severe pulmonary regurgitation with moderate pulmonary stenosis, severe pulmonary hypertension, moderate mitral regurgitation, repeated heart‑failure admissions, leg and abdominal swelling, impaired renal and hepatic function, and New York Heart Association (NYHA) Class III–IV symptoms. Multiple centres had deemed repeat open‑heart surgery prohibitively risky.
Evaluation and Planning
A multidisciplinary heart team at Kauvery Heart Institute, led by Dr Rajaram Anantharaman, Director of Transcatheter Heart Valve Therapies, conducted three‑dimensional echocardiography and cardiac CT imaging, concluding that both valves could be treated percutaneously. The strategy was reviewed extensively by an international panel of experts before proceeding.
Procedure Details
In a hybrid operating room under general anaesthesia, the pulmonary homograft was first prepared by deploying covered stents and performing balloon dilatation, after which a Medtronic Melody transcatheter pulmonary valve was implanted. The failing aortic autograft, lacking calcium for anchorage, was then treated with an Edwards Sapien 3 Ultra Resilia balloon‑expandable valve. Because of the absence of calcium, the team employed AI‑driven predictive modeling and virtual valve implantation to ensure precise sizing and positioning. Continuous transoesophageal echocardiography (TOE) guided the entire intervention.
Clinical Outcome
The patient experienced an uneventful recovery, spent a short period in the intensive care unit, and was discharged home. At a two‑week follow‑up, his symptoms had markedly improved: swelling resolved completely, he returned to NYHA Class I functional status, reported comfortable sleep, and was able to walk 20–30 minutes without limitation.
Statements
Dr Rajaram Anantharaman noted that patients with failure of both the aortic autograft and pulmonary homograft after a Ross procedure have very limited options, and that meticulous imaging, procedural planning, and multidisciplinary collaboration enabled this first‑of‑its‑kind percutaneous double‑valve rescue. Dr Aravindan Selvaraj, Co‑founder and Executive Director of the Kauvery Group of Hospitals, highlighted that advanced structural heart interventions are transforming treatment of complex valve disease and underscored the importance of experienced teams, advanced imaging, hybrid facilities, and cross‑specialty coordination.
Significance
To the best of the authors’ knowledge, this case represents the first reported instance in the published world literature of a completely percutaneous double transcatheter Ross rescue strategy, opening the possibility of treating carefully selected high‑risk patients who otherwise lack viable options.