Replacing Damaged Valves Without Open Heart Surgery, Successful in Europe

Marjorie Gibbs, 83, a retired school laundry worker from South London, has had a damaged valve replaced without an open heart surgery.

She is the first British patient to successfully undergo a new procedure now being experimented across Europe.

She had led an active life but in 2005 it was found she had aortic stenosis - a narrowing of the aortic valve which releases oxygenated blood from the heart to circulate around the body.

This is more common in old people because calcium deposits build up on the flaps of the valve over time.

The standard treatment is open-heart surgery, but this carries the risk of respiratory failure, organ failure and stroke.

Without an operation, though, her breathlessness would worsen, necessitating a wheelchair. The condition could even be fatal.

It was at this juncture she agreed to undergo the new procedure for replacing the damaged valve. The operation took place in August last in London.

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Olaf Wendler, consultant cardiothoracic surgeon and clinical director for cardiology and cardiac surgery at King's College Hospital, where the operation took place, explained to the Daily Mail:

Patients with aortic stenosis feel breathless and tired, even when resting.

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Until now, the only treatment has been valve replacement via open heart surgery, in which the patient is given a general anaesthetic and placed on a heart lung machine to keep the body alive while the heart is stopped.

The surgeon saws through the breastbone to replace the faulty valve with a prosthetic valve, which may be artificial or made of animal tissue.

The new transapical technique means we can replace a faulty aortic heart valve with a prosthetic one by inserting it directly through the apex or lowest point of the heart. The operation takes place with the patient under general anaesthetic.

A ventilator keeps the patient breathing properly. FIRST we make a 5cm incision between the fifth and six ribs on the left chest wall, directly above the heart's apex. We use X-ray and an echocardiogram to ensure we are in the right place. Then we open the muscles under the ribs until we can see the heart beating.

Next a needle is used to puncture the heart wall so we can insert a guide wire. A catheter is inserted with a balloon at its tip. Once in position, we dilate the balloon using a dye solution and push the calcified heart flaps against the wall of the aorta and out of the way to make room for the prosthetic valve.

A second catheter is used to place the prosthetic heart valve - a stainless steel mesh ring, slightly smaller than the original — within the faulty heart valve. A second balloon is dilated inside the prosthetic valve so it expands to 23mm or 26mm, depending on the size of the patient.

We check the prosthetic valve is working properly and that we are not obstructing the coronary blood vessels.

We then sew up the wall of the heart and the incision.

The procedure takes 90 minutes, compared to three hours' open-heart surgery.

Marjorie Gibbs said, “I took painkillers for the first week and there was a tiny scar on my chest. Now I can breathe properly again, shop and go to bingo. I think it's a wonderful achievement for the doctors, and I'm so proud to know I was the first British patient to undergo this procedure.”

But the technique is still undergoing trials.

Source-Medindia
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