Chennai, June 12, 2025: In a first for India, SIMS Hospital successfully performed a single-stage hybrid procedure combining an intraoperative transcatheter aortic valve replacement (TAVR) with the Frozen Elephant Trunk (FET) technique, a major open-heart surgery used to replace a damaged portion of the aorta with a specialised graft, on a 61-year-old patient from Mumbai who had previously undergone a complex cardiac procedure eleven years ago. During the 10-hour marathon hybrid surgery the patient was on heart-lung bypass for over 4 hours, and his heart was stopped for 2 hours to facilitate surgical steps.

The surgery was uneventful, and the patient was discharged just eight days after surgery, following a two-day stay in the ICU.

The FET procedure involves placing a hybrid graft, a combination of a surgical graft and a stent graft, resembling an elephant’s trunk. The upper portion replaces the aortic arch, while the lower stented part extends into the descending aorta and remains in place.

The patient had undergone Bentall surgery, a complex cardiac procedure where damaged aorta and aortic valve is removed and replaced with a composite graft and reattaching the coronary arteries to the new graft. The surgery was done on an emergency basis. Although the initial surgery was successful, the untackled parts of the aorta gradually dilated over time, increasing the risk of rupture and requiring further intervention. Additionally, his tissue valve had become severely narrowed and calcified. Together, the significantly enlarged aorta and the heavily calcified valve made this one of the most complex cardiac cases in India.

In his comments Dr. V.V. Bashi, Director & Senior Consultant at the Institute of Cardiac & Advanced Aortic Diseases, SIMS Hospital said, “Combining intraoperative catheter-based valve implantation with aortic arch repair is the first successful case in India of a TAVR and FET surgery performed for a redo Bentall patient. We had to perform two distinct procedures in a single sitting, as the patient had virtually no other treatment options. This groundbreaking approach demanded a delicate balance between precision and innovation. It was made possible by the collective expertise of our multidisciplinary team, including senior cardiothoracic surgeons, cardiac anaesthetists, specialist cardiac nurses, perfusionists, and technical staff. I’m extremely proud that we’ve demonstrated what’s possible when surgical boldness is matched with meticulous team planning.”

He further added that this procedure, “In high-risk aortic surgeries, this new approach enhances patient safety by significantly reducing bypass time and the duration of cardiac arrest. After surgery, the patient will remain on lifelong blood pressure medications. However, long-term use of blood thinners is not required.”

In his comments Dr. Mohammed Idhrees, Senior consultant, cardiothoracic surgery, SIMS Hospital said, “One of the most difficult cardiac cases in India was performed in a hybrid procedure. The surgery was precisely planned to execute, and the team faced absolutely no difficulties. The patient showed great courage and unwavering support which resulted in faster recovery. This case is noteworthy because it combined a TAVR and Frozen Elephant Trunk repair during a high-risk redo after a prior Bentall —yet everything was accomplished in a single, seamless surgery.”

Commenting on this landmark achievement Dr. Ravi Pachamuthu, Chairman, SIMS Hospital, said “This landmark procedure brings in a new era for our hospital and demonstrates our unwavering dedication to quality and innovation in cardiac care. Over the course of a hybrid operation, our team displayed remarkable surgical skill and endurance in handling one of India's most complicated cases: TAVR and FET surgery performed for a redo Bentall patient. I am incredibly proud of our staff and clinicians for providing our patients with top-notch care.”