AICTS doctors perform rare dual-valve implant, removing need for repeat open-heart surgery

The patient had previously undergone heart valve replacement but later developed severe tricuspid regurgitation

Doctors at the Army Institute of Cardio-Thoracic Sciences (AICTS) in Pune have successfully performed a rare and highly complex, catheter-based, dual-valve implantation on a patient with severe tricuspid valve leakage, eliminating the need for a second open-heart surgery, doctors said on Monday.

The minimally invasive procedure, known as bicaval transcatheter valve implantation (CAVI), involved the simultaneous implantation of two prosthetic valves in the superior vena cava (SVC) and inferior vena cava (IVC)—the two major veins that carry blood to the right side of the heart. (REPRESENTATIVE PHOTO)

The minimally invasive procedure, known as bicaval transcatheter valve implantation (CAVI), involved the simultaneous implantation of two prosthetic valves in the superior vena cava (SVC) and inferior vena cava (IVC)—the two major veins that carry blood to the right side of the heart. According to AICTS, the procedure marks a significant advancement in structural heart interventions within the armed forces medical services, and is currently performed at only a handful of specialised cardiac centres worldwide.

The patient had previously undergone heart valve replacement but later developed severe tricuspid regurgitation, a condition in which the tricuspid valve fails to close properly, causing blood to flow backwards into the body’s venous circulation, according to a statement issued by AICTS.

Patients with severe tricuspid regurgitation often suffer from debilitating symptoms such as swelling of the legs and abdomen, liver congestion, fatigue and breathlessness. In such cases, a repeat open-heart surgery carries a substantially higher risk of complications.

The AICTS statement further read: “The AICTS team adopted a minimally invasive, catheter-based approach, implanting two valves simultaneously in the veins leading to the right atrium. The newly-implanted valves prevent the backward flow of blood, improving circulation while avoiding the trauma associated with conventional surgery. The patient recovered successfully following the procedure.”

Cardiologists describe bicaval transcatheter valve implantation as an emerging treatment option for patients with severe tricuspid regurgitation, who are considered unsuitable for repeat surgery because of age, previous cardiac operations, or multiple medical conditions. Unlike transcatheter aortic valve replacement (TAVR) which is now widely practised, bicaval valve implantation remains an evolving procedure with limited global experience.

Medical experts said that the successful procedure reflects the growing adoption of advanced structural heart interventions in India, and highlights the increasing expertise available in catheter-based treatment of complex heart valve diseases that previously had limited therapeutic options.

The achievement adds another milestone to AICTS’ expanding portfolio of advanced cardiac procedures and reinforces its position as one of the country’s leading centres for complex cardio-thoracic care. For patients considered too high-risk for repeat open-heart surgery, such minimally invasive interventions could offer a safer, potentially life-changing alternative.