India’s First Transcatheter Mitral Valve Replacement (TMVR) was done in Apollo Hospitals, Chennai, by a team of experienced doctors led by Dr. Y. Vijayachandra Reddy, Interventional Cardiologist, and included Cardiac surgeons Dr. S. Vijayshanker, Dr. L. F. Sridhar, and Dr. Gopalamurugan, Interventional Cardiologist. This was the country’s first transcatheter valve-in valve MVR.
The patient was a 73-year-old frail gentleman who had undergone surgical mitral valve replacement (MVR) with a bioprosthetic valve (29 mm Magna valve) along with bypass surgery (venous graft to LAD) 10 years ago. However, he developed bioprosthetic valve degeneration after 10 years leading to severe valve leakage and atrial fibrillation with pulmonary edema and heart failure.
The only treatment option until recently has been that of re-do surgical bioprosthetic MVR which involves taking out the previously placed mitral valve. This is a very high-risk surgery in itself and was even more of a high-risk in our patient because of an existing functioning bypass graft, elderly age, frailty, associated comorbidities including lung problems, and higher anaesthetic risk.
Recently, the less invasive option of putting in a new bioprosthetic valve by transapical left ventricle (LV) route in a simpler hybrid procedure has become an attractive low-risk option in some advanced centres in the world, but has never been done in our country.
This option was considered the best for this frail gentleman and this was done with a special permission (12B approval from DGHS, India) and informed consent. The LV purse string for transcatheter MVR was placed in the operation theatre through mini anterolateral thoracotomy under general endotracheal anaesthesia, and he was shifted to cardiac catheterisation lab for the main procedure.
The left ventricle was accessed via the purse-stringed portion and over a guidewire placed in the right upper pulmonary vein, a 26F sheath was placed across the valve and a 30 mm Braile Inovare bioprosthetic valve was implanted with balloon inflation. Post-dilation with another balloon resulted in an excellent result with no mitral leak and good opening of the leaflets. The LV access was repaired and he was extubated the same evening.
He made an uneventful recovery and was discharged this week. Apollo Hospitals is the first and only Indian centre to have both transcatheter aortic and mitral valve replacements done. This procedure is ideal for valve-in-valve for degenerated bioprosthetic valve patients; this is a growing number of patients in the coming years. It also has promise for MVR in patients with dense MAC (mitral annular calcification). This case is one of the first in the country for the Cardiology department of Apollo Hospitals, Chennai.
