Doctors at Life Vincent Pallotti Hospital give new hope to elderly heart patients
While celebrating National Heart Awareness Month, Life Vincent Pallotti Hospital (LVPH), part of the Life Healthcare Group, is the first hospital in South Africa to implant over 100 Medtronic Transcatheter Aortic Valve Implants (TAVI).
TAVI is a minimally invasive heart procedure that replaces a damaged or narrowed aortic valve. The aortic valve is one of four main valves in your heart. It is the “outlet” valve that allows blood to leave the heart and travel to the rest of the body. With age and various diseases, calcium can build up in this valve and cause it to become extremely narrow. As a result, the aortic valve is unable to open properly. This is called aortic stenosis. This puts a huge strain on the heart and causes heart failure and even death.
“The TAVI procedure is offered to patients who are at high risk, usually over 80 years of age and who are not suitable for the standard aortic valve replacement open heart surgery. The less invasive nature of this procedure is more suitable for these high risk frail patients.
“Aortic valve replacement is recommended in such patients and the symptoms of aortic stenosis include breathlessness, chest pain, fatigue, dizziness and death. A TAVI procedure is one of the ways to repair this valve”, says Dr Adrian Horak, Cardiologist at Life Vincent Pallotti Hospital.
In 2016, Dr Adrian Horak, became a TAVI proctor for Medtronic and now assists with TAVI implantations in various hospitals around South Africa. “At the start of any medical programme, the new TAVI team is required to do at least 10 cases under the guidance of a proctor and thereafter they are able to carry on with the procedure on their own. Life Vincent Pallotti Hospital’s (LVPH) first TAVI procedure took place in September 2011, and seven years later over 100 procedures of its kind has been performed and we have had a 97% success rate”, says Dr Adrian Horak.
The valve is supplied by Medtronic, along with a delivery system and loading system. Medtronic gives technical support in assessing the valve sizes, in loading the valve at the time of theatre and the technical team is an intrinsic part of the TAVI team at Life Vincent Pallotti Hospital. The procedure is usually done via the right groin in the femoral artery. The cardiologist and cardio thoracic surgeon insert the valve into the femoral artery. It is placed across the aortic valve an inserted via the Medtronic delivery system. The valve is made up of natural tissue obtained from the heart of a pig, which has been specifically treated. The Medtronic Evolut R valve is a self-expanding Nitinol frame with the tissue valve implanted inside it. The new valve therefore functions normally replacing the old valve.
The procedure is not without risk which includes bleeding or vascular injury, arrhythmias or abnormal heart rhythms (sometimes requiring a pacemaker). The coronary arteries may be obstructed and Aortic regurgitation may occur. Renal impairment, stroke and death are rare complications.
The TAVI medical team at Life Vincent Pallotti Hospital consists of seven medical professionals, four cardiologists, Dr Adrian Horak, Dr Saleem Dawood, Dr Jens Hitzeroth and Dr Thayabran Pillay, two Cardio Thoracic surgeons, Dr Willie Koen and Dr Loven Moodley and an Anaesthetist, Dr Heinz Modler.
The medical team is supported by an excellent Cath Lab team consisting of two scrub sisters, one circulating anaesthetic nurse; a radiographer, a clinical technologist and a Medtronic clinical specialist who prepares the valve, Evert Meintjies.
“Life Vincent Pallotti Hospital Catheterisation Lab/ Heart Centre, is an accredited TAVI facility and has become a centre of excellence for treating patients with an array of heart diseases that need clinical intervention.
We are proud of the clinical accomplishments and milestones of our Cardiac Team and we are fortunate to have such highly skilled heart specialists, surgeons and nursing staff that can offer our patients this level of care and clinical intervention, of course with the support of our complementary services and medical aid funders. The 2018 global fee for one TAVI procedure is R384 174, the actual Valve amounts to R216 000 which is in most cases covered by our medical aid funders”, says Dr Japie du Toit, Life Healthcare Western Cape Regional Hospital Manager.
Another state of the art heart procedure was performed 2 months ago by Dr Vinod Thomas, an Electrophysiologist and Cardiologist, at Life Vincent Pallotti Hospital. Dr Thomas performed the first HIS-bundle pacing procedure for the hospital as well as in the Life Healthcare Hospital Group. “HIS bundle pacing is a relatively new technology that is now available in the cardiologist’s armamentarium, in the battle against heart failure.
Unlike conventional pacing, HIS bundle pacing engages the hearts intrinsic conduction system to get the ventricles to be activated and if done properly it can be used to narrow an interventricular conduction delay (wide QRS ) to within normal limits and thereby get the ventricles to contract more synchronously and thereby improve the overall heart function”, says Dr Vinod Thomas.
Complementary to the TAVI procedure, Life Vincent Pallotti Hospital offers another two specialised services to patients, one of them called “ECMO” treatment. Extracorporeal Membrane Oxygenation (ECMO) is an advanced treatment of life support for patients with respiratory or cardiac failure resistant to conventional critical care management. Known as a heart and lung bypass machine, ECMO therapy allows oxygen and carbon dioxide exchange
as well as cardiac assistance, while bypassing the heart and lungs. Although ECMO is not a cure for the underlying cause of cardiac or respiratory failure, it does allow time for patient recuperation and response to conventional therapies.
In addition, Life Vincent Pallotti Hospital has a comprehensive Stroke Unit made up of a highly skilled, multidisciplinary team, which consists of neurologists, physicians, radiologists, trauma doctors and nursing staff as well as an acute Life Rehabilitation Unit with physiotherapists, occupational and speech therapists and a Free Advanced Life Support Paramedic Service. This specialised team work together to offer efficient stroke care to patients all around the Western Cape. For 80 years Life Vincent Pallotti Hospital has been a significant landmark in Cape Town’s southern suburbs, serving patients throughout Cape Town and the City’s surrounding areas. Known to be the oldest private hospital facility in the Western Cape, it is still regarded as being one of South Africa’s top referral hospitals due to the extensive range of healthcare services it offers patients, all at one centrally located facility.