India’s First TAVI for Native Aortic Regurgitation Performed at Narayana Health City
Narayana Health City, Bengaluru has achieved a landmark in cardiac care, successfully performing India’s first Transcatheter Aortic Valve Implantation (TAVI) for pure native aortic regurgitation using the dedicated TAVR Device. The procedures were carried out by Dr. Suraj Narasimhan, Senior Consultant Cardiologist and Structural Intervention Specialist, and mark a pivotal shift in how high-risk patients with this complex valvular condition can be treated.
Aortic valve disease broadly falls into two categories
1) Stenosis, where the valve opening narrows progressively,
2) Regurgitation, where the valve fails to close fully, allowing blood to flow backward into the heart. Aortic regurgitation is the third most common valvular disease globally, and its burden is growing alongside an ageing population. More than 2% of those over 70 have at least moderate AR, and once symptoms develop, the prognosis deteriorates rapidly. While the past decade and a half has seen transcatheter techniques transform outcomes for aortic stenosis, pure aortic regurgitation remained a far more difficult condition to address without open-heart surgery. The reason lies in anatomy: stenosis typically involves calcium deposits that help to anchor a transcatheter valve in place, whereas pure aortic regurgitation has no calcified structure and hence no rigid anchoring zone for device fixation. This anatomical challenge long delayed the development of a dedicated transcatheter solution for the condition.
The HANCHOR valve system was engineered specifically to fill this gap. Designed for the distinct anatomical demands of pure aortic regurgitation, it enables a reliable transcatheter approach even in the absence of valvular calcium. The distinction matters: with early non-dedicated devices, procedural success rates for pure AR hovered around 67%. Dedicated systems have shifted that figure to approximately 95%, with studies also confirming lower rates of valve migration and meaningful reductions in 30-day and one-year mortality. These dedicated devices are not available in India, Narayana Health City Imported these devices with special government approval and deployed it in two patients for whom conventional open-heart surgery carried prohibitive risk. Both patients an 80-year-old and a 69-year-old male presented with severe aortic regurgitation and were assessed by the multidisciplinary heart team as high-risk surgical candidates, owing to advanced age and associated medical conditions. Following thorough evaluation including CT-TAVI protocol imaging, both were determined suitable for the transfemoral approach. The procedures were performed in the cardiac catheterization laboratory, each procedure was completed in approximately 45 to 60 minutes, without a surgical incision the valve delivered through an access point in the femoral artery at the thigh. Both patients were stabilised and discharged in good clinical condition within a short period of observation which is 48 hours.
“For years, elderly patients with severe aortic regurgitation who were deemed unfit for surgery had very limited options and that has real consequences. Conservatively managed severe AR carries a 2-year mortality of around 50%. The HANCHOR valve changes that equation entirely. This procedure delivers what previously required open-heart surgery, through a small puncture in the thigh, in under an hour, with patients back on their feet within 12 hours. It is a genuine turning point for this subset of patients, and we are proud that this chapter was written at
Narayana Health City.” Said Dr. Suraj Narasimhan, Senior Consultant Cardiologist & Structural Intervention Specialist, Narayana Health City, Bengaluru The TAVI/TAVR structural procedures are highly specialised non-surgical procedures for the treatment of advanced heart valve disease. Narayana Institute of Cardiac Sciences, Bengaluru has performed one of the highest number of TAVI/TAVR procedures in India. The department of structural heart disease at the centre has so far performed more than 750 procedures. Demographics and the aging population point towards a more than two fold increase in demand of these procedures.
The significance of this achievement extends well beyond these two cases. Across India, a substantial number of patients with valvular heart disease either present late or are turned away from surgical intervention because of age-related risk or coexisting conditions left without a viable path forward. The successful deployment of a dedicated transcatheter platform for aortic regurgitation now opens a meaningful treatment option for this group: less invasive, lower procedural risk, and a faster return to everyday life. For Narayana Health, this milestone is consistent with a longer commitment to ensure that advances at the frontier of cardiac intervention reach patients in India without compromise. By investing in emerging technologies and building the clinical infrastructure to deploy them safely, the institution continues to close the distance between what is available globally and what patients here can access at home
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