SIMS Hospital Achieves India’s First Single‑Stage Hybrid TAVR & Aortic Graft Surgery

SIMS Hospital, Chennai, has marked a groundbreaking achievement in Indian cardiac care by performing the nation's first-ever hybrid intraoperative Transcatheter Aortic Valve Replacement (TAVR) along with a Frozen Elephant Trunk (FET) aortic graft surgery in a single sitting. This complex redo heart surgery was carried out on a 61-year-old patient who had previously undergone emergency Bentall surgery over a decade ago.

The patient, a businessman from Mumbai, had developed severe aortic stenosis and dilatation of the residual aorta due to long-term degeneration of the previously implanted tissue valve. This resulted in shortness of breath and a heightened risk of life-threatening complications, demanding urgent and advanced intervention. Given the risks associated with a repeat open-heart surgery, the SIMS Hospital cardiac team opted for a novel hybrid surgical strategy.

In a highly coordinated procedure that lasted over 10 hours, the surgical team successfully performed the FET procedure—a method where a hybrid prosthesis (a combination of fabric and stented graft) is used to reconstruct the aortic arch and descending aorta. Simultaneously, a Transcatheter Aortic Valve Replacement (TAVR) was carried out intraoperatively, making the process significantly less invasive compared to conventional valve replacement techniques.

One of the unique aspects of this hybrid procedure was that the TAVR was performed intraoperatively instead of using the traditional transfemoral or transapical approach. This not only reduced operative time but also eliminated the need for high-risk re-entry and valve explantation. ^[1] The team managed 4 hours of cardiopulmonary bypass and 2 hours of circulatory arrest, completing the surgery with high precision.

Postoperatively, the patient had a remarkably smooth recovery. He spent two days in the ICU, was moved to the general ward, and was discharged eight days after surgery. The doctors confirmed that he would not need long-term anticoagulants but will have to continue with regular blood pressure medications. ^[2]

Dr. V.V. Bashi, Director of the Institute of Cardiac & Aortic Disorders at SIMS Hospital, explained that this was the first time in India that intraoperative TAVR and FET were combined in a redo Bentall case. According to him, the hybrid approach significantly reduces surgical trauma and recovery time while increasing long-term safety for high-risk patients.

SIMS Hospital’s Chairman, Dr. Ravi Pachamuthu, emphasized that this landmark surgery exemplifies the hospital’s commitment to combining clinical excellence with innovation. This pioneering effort not only puts SIMS Hospital on the global map for complex cardiac care but also opens new possibilities for hybrid procedures in redo cardiac surgeries.

References:

1. Li B, Sun L, Chang Q, et al. Early and long-term outcomes of total arch replacement with frozen elephant trunk technique in patients with previous cardiac surgery. Eur J Cardiothoracic Surg. 2022;61(4):769–776.

2. Shrestha M, Martens A, Maeding I, et al. Total aortic arch replacement with frozen elephant trunk: a systematic review. Ann Cardiothoracic Surg. 2013;2(5):581–591.

(Input from various sources)

(Rehash/Sakshi Thakar/MSM)