In a groundbreaking medical procedure, Dr. AB Gopalamurugan and the advanced 24/7 heart failure department at MGM Healthcare Malar Adyar have successfully performed the first Emergency Transcatheter Aortic Valve Replacement (TAVR) with Aortic Ultrasound (AVUS) in India. This innovative procedure was performed on a 70-year-old patient in cardiogenic shock due to critical aortic stenosis and severe left ventricular dysfunction.

The patient, who arrived at the Emergency Room in crashing cardiogenic shock and pulmonary edema, was facing an admission mortality rate of 50%. An echocardiogram revealed an ejection fraction (LVEF) of just 20%, alongside critical aortic valve stenosis and mitral regurgitation (MR). Despite being on two inotropes for blood pressure support, the patient’s condition was deteriorating rapidly, making a traditional cardiac CT scan unfeasible.

This emergency TAVR procedure is the first of its kind in India, setting a new benchmark in cardiac care. Traditionally, TAVR procedures are planned using contrast-enhanced CT scans to guide the placement of the new valve. However, in this unique case, the patient’s critical condition and inability to undergo a CT scan necessitated an alternative approach. Aortic Ultrasound has been used for the first time in India to guide a TAVR procedure. Unlike the conventional approach that relies on contrast-enhanced CT scans, AVUS provides real-time, high-resolution imaging without the need for contrast agents. This is particularly beneficial for patients with compromised renal function or those who cannot undergo a CT scan.

Dr. AB Gopalamurugan, Senior Consultant – Interventional Cardiology and Electrophysiology Director – TAVR and Endovascular Therapy Director, MGM Malar Adyar and his team leveraged Aortic Ultrasound (AVUS) technology to plan and execute the valve replacement. AVUS offers real-time, high-resolution imaging of the aortic valve, allowing precise placement without the need for contrast agents. This method not only mitigates risks associated with contrast use, such as kidney damage, but also provides a quicker and more efficient solution in emergency settings.
Dr. AB Gopalamurugan, Senior Consultant – Interventional Cardiology and Electrophysiology Director – TAVR and Endovascular Therapy Director, MGM Malar Adyar commenting on the success of the procedure, said, “Using Aortic Ultrasound for the first time in India to plan and guide this emergency TAVR procedure is a testament to our commitment to pioneering advanced medical solutions. Remarkably, this life-saving intervention was performed under local anesthesia, immediately stabilizing the patient and restoring normal left ventricular function. The patient’s recovery and rapid discharge highlight the transformative impact of this technology. Performing a TAVR procedure in an emergency setting under local anesthesia is a rare and complex task. The use of AVUS enabled the team to make quick, precise decisions, significantly reducing the time and risk associated with traditional methods.”

In just 48 hours, the patient was discharged, walking home with her mortality risk drastically reduced from 50% to 1%. This remarkable turnaround showcases the efficacy and potential of AVUS in emergency cardiac care, marking a significant milestone in Indian medical history.
The successful implementation of AVUS in this emergency TAVR procedure underscores MGM Malar’s position at the forefront of medical innovation. By adopting cutting-edge technologies and techniques, the hospital continues to enhance patient outcomes and set new standards in cardiac care.