Rare Life-Saving Cardiac Procedure by Dr. Gautam Naik Offers Hope to Patient with Advanced Right-Sided Heart Failure

The patient had previously undergone surgical tricuspid valve replacement in 2011 using a bioprosthetic valve (Perimount 29 mm) in the context of a right atrial mass. Over time, the valve degenerated, as is typical with bioprosthetic valves, occurring in her case after nearly 15 years. When she presented again, she was found to have torrential tricuspid regurgitation along with significant valve gradients (peak/mean: 16/10 mmHg) and severe right ventricular dysfunction, placing her in a very high-risk category.

Given the complexity of her condition, she had been declined for further intervention at multiple leading centres across the country.

At Indraprastha Apollo Hospital, New Delhi, the Heart Valve team, led by interventional cardiologist Dr Gautam Naik as the primary operator, undertook a transcatheter valve-in-valve procedure, an advanced, minimally invasive technique. Surgical expertise and post-procedural intensive care support were provided by Dr Mukesh Goel and Dr Deepa Sarkar respectively, in conjunction with the hospital’s cardiac intensive care team.

A Sapien Ultra Resilia 29 mm transcatheter heart valve was successfully implanted within the failing surgical valve. Intra-procedural transesophageal echocardiography confirmed complete elimination of the regurgitation, with an excellent immediate post-procedural gradient of just 2 mmHg.

The post-operative period, however, posed significant challenges. The patient continued to have right ventricular dysfunction, accompanied by low blood pressure and reduced urine output in the initial days. She required intensive care support, including inotropes and careful fluid management.

Over the following days, her condition steadily improved. Right ventricular function began to recover, urine output normalized, and her blood pressure stabilised, allowing gradual withdrawal of inotropic support.

She was discharged within six days in stable condition. At one-week follow-up, she reported dramatic symptomatic improvement and has since returned to her home country.

Doctors at Apollo described the case as a “grand success,” highlighting not just the technical achievement but the meaningful clinical recovery in a patient who had exhausted conventional options.

“This case underscores the evolving role of transcatheter therapies in managing complex valvular heart disease, especially in patients considered inoperable,” said Dr Naik. “What makes this especially rewarding is the patient’s recovery despite significant pre-existing right ventricular dysfunction.”

The case adds to the growing body of evidence supporting minimally invasive valve-in-valve therapies and reinforces the capability of Indian centres in performing cutting-edge structural heart interventions.