First Ever Percutaneous Trans-Axillary TAVI in India

Heart Valve Replaced Without Surgery Through Arm Artery

• Dr. Yashpal Goyal

JAIPUR, INDIA (TIP):  Now nothing to worry for patients who are having unfortunately both legs’ blocked arteries and they need valve replacement without surgery as the Interventional Cardiologists team in Rajasthan performed successfully Percutaneous Trans-Axillary (PTA) to replace non-working heart valve of a patient through “Arm Artery” without surgery.

Dr. Ravindra Singh Rao, renowned Interventional Cardiologist at Rajasthan Hospital in Jaipur claimed, “In India, around 3–5% of patients suffering from aortic stenosis may have blocked femoral arteries, making the standard TAVI approach unfeasible. For such patients, this alternative arm artery route can be life-saving.”

The patient, a 78-year-old man (name changed to Hemendra), had severely blocked arteries in both legs due to calcium buildup, which made the conventional transcatheter valve implantation through the femoral artery impossible.

Cardiologists team led by Dr. Rao performed this innovative and life-saving procedure, claiming it as the first such case in India. Normally, TAVI (Transcatheter Aortic Valve Implantation) is done by passing an artificial valve through the femoral artery in the thigh. However, in Hemendra’s case, this route was blocked, and the patient’s heart was functioning at only 25% capacity. The patient also had difficulty breathing, worsening kidney function, and had previously undergone two stent procedures, according to Dr Rao.

Refusing to give up, Dr. Rao’s team opted for a rare and complex approach. Using ultrasound guidance, they precisely punctured the subclavian artery near the collar-bone in the left arm. A small tube (sheath) was inserted, followed by placement of a percutaneous suture system to secure the access point. A larger delivery system was then advanced through the artery, allowing the team to successfully implant the new artificial heart valve.

After valve deployment, the artery was sealed using a ProGlide closure device. Until now, the subclavian artery route for TAVI in India was used only through open surgery, the first ever percutaneous (completely non-surgical) trans-axillary TAVI in the country.

The patient’s symptoms improved almost immediately after the procedure. His breathing eased, kidney function normalized, and heart efficiency improved significantly. He was discharged from the hospital just five days later, fully stable. The success of the percutaneous trans-axillary TAVI has demonstrated that with innovation and courage, even the most complex medical challenges can be overcome, Dr Rao told TIP.

[Key Highlights:

• First-ever heart valve replacement through the arm artery without surgery in India
• Conventional femoral route was blocked due to severe calcification
• Patient’s heart functioning only at 25%; kidneys also deteriorating
• Innovative approach led to full recovery; patient discharged in 5 days
• Sets a new path of hope for patients with similar vascular limitations.

( Dr. Goyal is Senior Correspondent in Jaipur. He is a Foreign Correspondent,  The Indian Panorama. Formerly with PTI | The Tribune | Lokmat Times | The Statesman . He can be reached on 9414043334)