The Heart Valves
The Four Heart Valves —
What Goes Wrong and Why
The heart has four valves that act as one-way doors, ensuring blood flows in the correct direction through the heart chambers. When a valve becomes diseased — either too stiff to open properly (stenosis) or too leaky to close properly (regurgitation) — the heart has to work harder, eventually leading to heart failure if untreated.
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Aortic Valve
Between left ventricle and aorta. Most commonly replaced valve. Aortic stenosis and regurgitation both treatable surgically and via TAVI.
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Mitral Valve
Between left atrium and left ventricle. Most commonly repaired valve. Mitral prolapse, stenosis, and regurgitation treated surgically.
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Tricuspid Valve
Between right atrium and right ventricle. Usually repaired alongside mitral valve surgery. Tricuspid regurgitation most common condition.
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Pulmonary Valve
Between right ventricle and pulmonary artery. Pulmonary valve disease most commonly congenital. Treated surgically when severe.
Core Principle
Repair Is Always Preferred
Over Replacement
This is the guiding surgical principle at KG Hospital and at the best cardiac centres worldwide. The patient’s own valve, when successfully repaired, outperforms any prosthetic substitute in durability, function, and quality of life — and crucially, avoids the need for lifelong anticoagulation medication.
✓ Valve Repair — When Possible
Preserves the patient’s natural valve tissue
No prosthetic valve — nothing artificial in the heart
No lifelong blood thinners (anticoagulation) required
Better long-term durability than any prosthetic valve
Lower risk of endocarditis (valve infection)
Available for most mitral valve disease and selected aortic cases
→ Valve Replacement — When Repair Is Not Possible
Used when valve is too severely diseased to repair
Biological (tissue) valve: no long-term anticoagulation, lasts 15–20 years
Mechanical valve: lifelong warfarin required, extremely durable
Suture-less valves (Babliak technique) — shorter surgery time
Available via open surgery, MICS, Robotic, or TAVI (aortic only)
Surgical Procedures
Valve Procedures at
KG Hospital
The following valve procedures are performed at KG Hospital — via open, MICS, or Robotic approaches depending on suitability.
01
Mitral Valve Repair
Repair of the mitral valve by reshaping leaflets, chordae, or the annulus. Preferred approach for mitral prolapse and regurgitation. Available via open surgery, MICS, and robotic approaches.
02
Mitral Valve Replacement
Biological or mechanical prosthetic mitral valve replacement when repair is not possible. Can be combined with CABG in one operation — an India first via MICS at KGH.
03
Aortic Valve Replacement
Surgical replacement of the aortic valve. Includes suture-less Babliak technique and Robotic suture-less approach — both India firsts at KGH. Biological and mechanical valve options.
India Firsts ×2
04
Double Valve Replacement
Simultaneous replacement of both aortic and mitral valves. KGH performed India first transaxillary double valve replacement via MICS — through the armpit, zero chest incision.
India First
05
Tricuspid Valve Repair
Repair of the tricuspid valve, typically performed alongside mitral valve surgery. Annuloplasty ring repair is standard. Standalone tricuspid repair available when required.
06
Redo Valve Surgery
Re-operation for patients with failed prosthetic valves, deteriorated biological valves, or prior valve repair that has broken down. Complex cases accepted for second opinion and re-operation.
Surgical Approach
Choose Your Approach —
Open, MICS, Robotic, or TAVI
KG Hospital is the only hospital in Coimbatore offering surgical valve procedures through all three minimally invasive approaches alongside conventional open surgery. The right approach depends on your valve anatomy, overall health, and recovery priorities.
| Feature |
Robotic |
MICS |
TAVI* |
Open Surgery |
| Incision | <1 cm (×3) | 2–3 inch | Groin catheter | 8–12 inch |
| Sternum cut? | No | No | No | Yes |
| Hospital stay | 2–3 days | 3–5 days | 2–4 days | 7–10 days |
| Full recovery | 1–2 weeks | 3–4 weeks | Days to 2 weeks | 6–8 weeks |
| Valves treated | Aortic, Mitral | All valves | Aortic only | All valves |
| In Coimbatore | KGH only | KGH only | KGH Cardiology | Multiple |
* TAVI is a non-surgical catheter procedure performed by the Cardiology team, not the cardiac surgery team. See TAVI details →
National Record
3 India Firsts in
Heart Valve Surgery
No other hospital in Coimbatore has achieved a national first in valve surgery. KG Hospital has achieved three.
1
First in India: Robotic Suture-less Aortic Valve Replacement
Replacement of the aortic valve using the Da Vinci robotic system with a suture-less prosthetic valve — deployed robotically without any stitching. Traditional valve replacement requires the surgeon to suture the prosthetic valve in place, which takes time and requires the heart to be stopped for longer. The suture-less technique reduces the aortic cross-clamp time (heart-stopped time), lowers operative risk, and improves haemodynamic performance of the new valve. Performed robotically through tiny keyhole incisions. First performed in India at KG Hospital.
2
First in India: Transaxillary Aortic & Double Valve Replacement (MICS)
Replacement of both the aortic and mitral valves simultaneously, accessed through an incision in the armpit (transaxillary approach) with zero incision on the chest wall. Conventional MICS uses a 2–3 inch right chest incision. This transaxillary approach eliminates even that small chest incision entirely — the two valve replacements are performed through the armpit. This is among the least invasive double valve replacements performed anywhere in the world. First performed in India at KG Hospital.
3
First in India: Aortic Valve Replacement via Babliak Technique
The Babliak technique is an advanced minimally invasive approach for aortic valve replacement that uses a suture-less prosthetic valve allowing the valve to be deployed and anchored without suturing it into place. Developed in Europe, the technique significantly reduces the cross-clamp time and simplifies the implantation, producing excellent haemodynamic outcomes. KG Hospital was the first hospital in India to adopt and perform this technique, bringing cutting-edge European valve surgery innovation directly to patients in Coimbatore.
Prosthetic Valves
Biological vs Mechanical —
Choosing the Right Replacement Valve
When valve replacement is necessary, two main prosthetic valve types are available. The choice depends primarily on age, lifestyle, and tolerance for lifelong anticoagulation medication. Your surgeon will discuss the options and recommend the most appropriate valve for your situation.
🌿Biological (Tissue) Valve
Made from animal tissue (porcine or bovine pericardium)
Does not require lifelong anticoagulation in most patients
Lasts 15–20 years — may need replacement in younger patients
Preferred for patients over 65 or those with bleeding risk
Feels most like a natural valve hemodynamically
Includes suture-less tissue valves (Babliak / rapid deployment)
⚙Mechanical Valve
Made from titanium alloy and pyrolytic carbon
Lifelong warfarin anticoagulation required — to prevent clotting
Extremely durable — expected to last the patient’s lifetime
Preferred for younger patients (<65) to avoid future re-operation
Requires regular INR blood monitoring for warfarin dose adjustment
A faint clicking sound may be audible in quiet environments
Note on suture-less valves: KG Hospital also offers suture-less biological valves (Babliak technique and robotic suture-less) which combine the benefits of tissue valves with shorter cross-clamp times — two India firsts achieved at KGH. Ask your surgeon if you are suitable for suture-less valve replacement.
Non-Surgical Option
TAVI — Aortic Valve Replacement
Without Open Heart Surgery
TAVI (Transcatheter Aortic Valve Implantation) replaces a diseased aortic valve through a catheter — typically via the femoral artery in the groin — without any chest incision and without stopping the heart. It is the treatment of choice for elderly patients and those with high surgical risk for whom open valve replacement carries unacceptable risk.
TAVI is performed by the Cardiology team at KG Hospital, not the cardiac surgery team — it is a catheter-based procedure, not a surgical one. A multidisciplinary Heart Team (cardiologists + cardiac surgeons + anaesthetists) reviews each patient to confirm TAVI suitability and select the optimal valve and approach.
Full TAVI details in Cardiology →
TAVI at a Glance
✓No open-heart surgery — catheter through the groin
✓Heart continues beating throughout
✓Hospital stay 2–4 days
✓Most patients mobile within days
→Aortic valve only (not mitral or tricuspid)
→For high-risk / elderly patients unsuitable for surgery
→Requires multidisciplinary Heart Team assessment
Recovery
Recovery After
Valve Surgery
Recovery depends primarily on the surgical approach used. All patients spend time in the Cardiac ICU immediately after surgery before moving to the cardiac ward.
1
Surgery & Cardiac ICU
Valve surgery is performed under general anaesthesia. Monitoring in Cardiac ICU begins immediately post-surgery. Most patients are extubated (breathing tubes removed) within hours of surgery and are awake and responsive the same evening.
Day of surgery
2
Cardiac Ward Transfer
Stable patients move to the cardiac ward on day 1. Chest drain and lines are removed progressively. Physiotherapy begins — patients are encouraged to sit up and walk short distances from day 2.
Day 1–2
3
Discharge
Open surgery: day 7–10. MICS: day 3–5. Robotic: day 2–3. TAVI: day 2–4. Discharge package includes: medications (including anticoagulation if required), wound care instructions, activity guidelines, and follow-up appointments.
Depends on approach
4
Full Recovery & Anticoagulation
Open surgery: 6–8 weeks. MICS: 3–4 weeks. Robotic: 1–2 weeks. Patients with mechanical valves begin warfarin immediately and require lifelong monitoring. Biological valve patients do not require long-term anticoagulation in most cases. Follow-up echo at 6 weeks and annually thereafter.
3–8 weeks depending on approach
