Kauvery Hospital Alwarpet Makes Global Medical History with Rare TAVR-in-TAVR-in-SAVR Procedure

Chennai, 22 January 2026: Kauvery Hospital, Alwarpet has successfully performed a highly complex and rare TAVR-in-TAVR-in-SAVR procedure with bioprosthetic valve fracture on a 78-year-old patient, marking one of the first such interventions globally. The advanced transcatheter procedure addressed a repeatedly failing aortic valve in a patient with a long history of aortic valve disease.

L-R : Dr Mahesh Kumar , Medical Superintendent Kauvery Hospital Alwarpet; Dr Deep Chandh Raja Senior Consultant & Lead- Cardiac Electrophysiology, Dr Srikumar Senior Consultant Cardiologist, Dr Rajaram Ananthraman, Senior Consultant Interventional Cardiologist, Dr Aravindan Selvaraj, Co Founder and Executive Director Kauvery Group of Hospitals, Dr Asik Ali Consultant Cardiac Radiology, Dr Iyappan Ponnuswamy Medical Director Kauvery Hospital, Dr Kamal Kanth Associate Consultant Cardiology, Dr Nedumaran Senior Consultant Cardiac Anesthesiologist, Kauvery Hospital

The patient initially underwent surgical aortic valve replacement (SAVR) in 2005 for severe aortic stenosis, followed by a TAVR valve-in-valve procedure in 2019 after degeneration of the surgical valve. In recent years, he again developed breathlessness and fatigue due to rising valve pressure gradients caused by leaflet thickening and thrombosis, leading to early degeneration of the transcatheter valve. Given his advanced age and high surgical risk, repeat open-heart surgery was not considered ideal.

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A multidisciplinary heart team at Kauvery Hospital, led by Dr. Rajaram Anantharaman and Dr. C. Sundar, conducted detailed evaluation using advanced 3D echocardiography and CT imaging. The team opted for a TAVR-in-TAVR-in-SAVR approach, implanting a new transcatheter valve within the previous transcatheter valve and surgical valve. To ensure optimal valve expansion and blood flow, a bioprosthetic valve fracture technique was employed, along with dual cerebral protection using Spider FX devices to minimise stroke risk.

The procedure was further complicated by the patient’s bicuspid aortic valve anatomy, associated aortopathy, and pseudo-coarctation, but was completed successfully. The patient recovered rapidly, was shifted to the ward the next day, and discharged within 48 hours with excellent valve function and no neurological complications.

Commenting on the case, Dr. Rajaram Anantharaman, Director – Transcatheter Heart Valve Therapies, said the outcome highlights the precision and expertise of the heart valve team. Dr. Aravindan Selvaraj, Co-Founder and Executive Director, Kauvery Group of Hospitals, noted that such complex procedures being performed locally reinforce Chennai’s emergence as a centre for advanced cardiac care.

Kauvery Hospital, Chennai continues to strengthen its leadership in structural heart disease management through cutting-edge transcatheter therapies and comprehensive multidisciplinary care.

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