Complex Valve Repair: Advanced Heart Valve Care at STAR Hospitals

Heart valve disease does not always follow a simple pattern. A valve may become narrowed, fail to close properly, or develop more than one problem at the same time. Previous heart surgery, infection, rheumatic heart disease, calcification, congenital abnormalities and age-related degeneration can make treatment considerably more complicated.

For these patients, deciding on a procedure is only one part of the challenge. The bigger question is which procedure is appropriate, and can the valve be repaired safely and durably?

This is where a specialised valve team, detailed imaging and experience with both surgical and catheter-based procedures become important. Multidisciplinary Heart Teams and experienced heart valve centres benefit patients with complex valve disease very much.

When Does Valve Disease Become Complex?

Valve disease can involve the aortic, mitral, tricuspid or pulmonary valve. Some patients have a straightforward single-valve problem; others have anatomy or medical conditions that make treatment more challenging.

Complex cases may include:

• Severe mitral regurgitation or mitral stenosis
• Severe aortic stenosis or aortic regurgitation
• Significant tricuspid regurgitation occurring alongside other valve disease
• Multiple or mixed valve disorders
• Previously operated or replaced valves that have developed complications
• Valve disease in patients with heart failure or reduced heart function
• Patients who have a high risk for conventional open-heart surgery

Symptoms can be surprisingly easy to dismiss. Breathlessness while walking, unusual fatigue, swelling of the feet, chest discomfort, dizziness or fainting may gradually be accepted as part of getting older. In reality, these can be signs that a diseased valve is putting increasing strain on the heart.

Repair or Replacement? The Decision Starts With the Valve Itself

Valve repair is particularly important in conditions such as mitral regurgitation, where the patient's own valve may be suitable for reconstruction. Repair can preserve the native valve and, when a durable repair is achievable, may offer important long-term advantages.

There is an important role to surgical mitral valve repair in suitable patients with severe primary mitral regurgitation, particularly when a durable repair is likely and the procedure is performed at an experienced Heart Valve Centre.  Replacement remains necessary when the valve cannot be repaired reliably.

At STAR Hospitals, cardiac surgery services include mitral valve repair/replacement, aortic valve replacement, reoperative cardiac surgery and minimally invasive cardiac surgery.

Not Every Valve Problem Requires Open-Heart Surgery

This is one area where structural heart treatment has changed considerably. For carefully selected patients, valve intervention can be performed through a catheter rather than through conventional open-heart surgery. STAR Hospitals' minimally invasive cardiac programme includes TAVI/TAVR for aortic valve disease and MitraClip for mitral regurgitation, along with image-guided structural heart procedures.

TAVI for Aortic Valve Disease

Transcatheter Aortic Valve Implantation (TAVI) can replace a diseased aortic valve without opening the chest. A replacement valve is delivered through a catheter, usually via the femoral artery.

It has become particularly important for older patients and those in whom conventional surgery carries greater risk. Whether TAVI or surgical aortic valve replacement is appropriate depends on factors such as age, valve anatomy, surgical risk, life expectancy and patient preference.

TEER/MitraClip for Mitral Regurgitation

For selected patients with significant mitral regurgitation who are unsuitable for surgery or have a high surgical risk, Transcatheter Edge-to-Edge Repair (TEER) may be an option.

STAR Hospitals offers the MitraClip procedure, in which a small clip is delivered through a catheter and used to bring the mitral valve leaflets together, reducing the backward flow of blood. Detailed echocardiography, including transesophageal echocardiography, along with other investigations helps determine whether the patient's valve anatomy is suitable.

Why Advanced Imaging Matters

With complex valve disease, an echocardiogram is not enough. The team may use transthoracic and transesophageal echocardiography, CT imaging and cardiac catheterisation to understand the valve's structure, the severity of disease, heart function and whether a surgical or transcatheter procedure is technically feasible. This detailed assessment matters because two patients with the same diagnosis on paper may require completely different treatments.

At STAR Hospitals, structural heart specialist Dr. Rajesh Natuva has advanced fellowship training in TAVR, TMVR and TEER, along with expertise in TEE and structural heart interventions.

A Heart Team Approach at STAR Hospitals

Complex valve treatment rarely belongs to one specialty alone. A patient's case may need input from an interventional cardiologist, cardiac surgeon, cardiac imaging specialist, anaesthetist, intensivist and heart failure team before a treatment plan is finalised.

STAR Hospitals' cardiac services bring these disciplines together, supported by modern catheterisation laboratories, hybrid operating rooms, advanced imaging and cardiac surgical facilities. Its cardiac surgery department also performs minimally invasive cardiac procedures and has experience with reoperative cardiac surgery.

For a patient with complex valve disease, this means the treatment discussion can cover the full range of possibilities—from valve repair and surgical replacement to TAVI and catheter-based mitral repair—rather than approaching every valve problem in exactly the same way.

When Should You Seek an Evaluation?

Do not wait for severe symptoms before having a valve problem assessed. Breathlessness that is new or worsening, reduced exercise tolerance, swelling of the legs, chest discomfort, palpitations, dizziness or fainting warrants medical evaluation, particularly if a valve abnormality has already been diagnosed. The earlier the valve, heart function and overall risk are assessed, the more clearly the available treatment options can be weighed.

At STAR Hospitals, Hyderabad, patients with complex heart valve disease have access to surgical and minimally invasive treatment options supported by advanced imaging and a multidisciplinary cardiac team. The emphasis is on understanding the valve, the patient and the risks together before deciding whether repair, replacement or a catheter-based intervention is the right course