One-stop heart op to repair faulty valves AND unblock your arteries
A NEW two-in-one op mends leaky heart valves and blocked arteries at the same time without the trauma of open-heart surgery. Cherie Bason, 65, a retired bank cashier from Southend-on-Sea, was the first British patient to have the treatment, as she tells SOPHIE GOODCHILD.
THE PATIENT
Doctors diagnosed me with heart disease when I was in my 40s. I’d been getting a pain in my upper left arm when walking to work. tests showed my levels of bad (LDL) cholesterol were relatively high and scans revealed one of the arteries supplying my heart had become narrowed with fatty plaque.
I had an angioplasty — where they unblock your artery using a balloon to squash the blockage out of the way — and they also put in a stent, a tiny tube to keep the artery open.
I was put on aspirin (75mg daily) to prevent clots and a statin, and told to cut fatty foods from my diet. I’m 9 st and 4 ft 11 in, so not overweight.
But doctors thought my body simply didn’t deal with cholesterol very well. After the surgery I felt healthy and started going to the gym and even attended high-energy aerobics sessions.
then, in october 2013, I developed a tightness in my chest — it was a heart murmur, an unusual sound caused by disturbed blood flow through the heart.
I was referred to southend University Hospital for a heart ultrasound. this showed that one of my heart valves was leaking — one of the two flaps in the valve was floppy, so blood was flowing back through it. that meant my heart couldn’t pump efficiently.
the diagnosis was a huge shock — I was told open-heart surgery was necessary. the leaky valve would be replaced with a mechanical one and I’d be on the blood-thinner warfarin for the rest of my life to reduce the risk that blood clots could catch in the new valve and stop it working.
I was also told that plaque is more likely to accumulate from a mechanical valve, which in turn could trigger a clot.
THE recovery time from surgery was three months, which was a real concern for me. In February 2014, I had a cardiogram, where you’re put on an exercise bike, which showed my heart was struggling. I was also referred for an angiogram, which shows blood flow through the arteries. I now had a second artery that was severely blocked, restricting blood flow, so I’d need another stent.
I was expecting to have both operations done at once via openheart surgery. But when I saw Mr Inderpaul Birdi, in August last year, he told me that instead of replacing my heart valve he could repair it and put a stent into the blocked artery during the same keyhole procedure.
I wouldn’t need warfarin or open-heart surgery.
Instead, he’d make an incision in my groin and just a small one in my chest and feed the stent through these, as well as repairing the valve the same way, using tiny instruments via a tube. I’d be home within days i nstead of spending weeks in hospital.
I went into hospital for the fivehour operation in April, by which time I was feeling sluggish and breathless going up stairs.
Afterwards there was no pain. I was up walking on the ward straight away and home four days later. I’m still on aspirin, but I’m amazed how much better I feel after such a relatively short space of time.
THE SURGEON
Mr Inderpaul Birdi is a consultant cardiac surgeon at the essex Cardiothoracic Centre at Basildon university hospital. Nearly three million people in the UK have coronary artery disease, where the major blood vessels supplying the heart become narrowed. the flow of blood to the heart becomes restricted, causing chest pain (angina) and breathlessness, or a heart attack.
Another common heart condition is valve disease. there are four main heart valves — one for each chamber — and in cherie’s case her mitral valve, which controls blood flow into the bottom left chamber of the heart (which pumps oxygen-rich blood through the heart to the rest of the body) was leaking.
A valve has two flaps, which are supported by tendons that close the valve properly. However, these tendons can tear — as a result of age, your genes or even a heart infection — and so one or more of the flaps becomes floppy.
Another problem is that the tissue which the flap itself is made of can also degenerate.
Heart valve disease, as this is known, can in turn trigger heart failure, where the heart can’t pump enough blood around the body.
Every year in the UK around 5,000 people undergo surgery to treat both these problems — usually carried out in one operation via open heart surgery.
This is risky, though. The surgeon has to make a long (18cm) incision in the chest and cut the breastbone in two to get to the heart, which can result in wound infections and blood loss.
And the hospital stay is at least 14 days with 12 weeks’ recovery time. some patients are offered two separate keyhole procedures as an alternative, but this involves two hospital admissions, which is costly to the NHs.
What I have been perfecting with Paul Kelly, a consultant cardiologist at southend Hospital, is a two-in-one keyhole operation to widen narrowed arteries and repair defective heart valves during the same this procedure. hybrid operation can only be performed in a specialised theatre that combines cardiology and surgery facilities. Keyhole treatment means faster healing times of around seven to ten days. the scarring is minimal.
After giving cherie a general anaesthetic, we first performed the angioplasty, injecting dye into the blocked artery to show the blood vessels on an X-ray.
We then made a 5mm incision in cherie’s right groin, threading a 1mm-wide tube with a balloon attached into the affected artery. the balloon was inflated to stretch the narrowed artery to normal size, then a stent was passed up to the artery to prevent the area collapsing.
to repair the valve, we have to stop the patient’s heart. cherie was connected via a tube inserted i n her chest to a heart- l ung machine that keeps oxygen-rich blood flowing through the body. cherie’s heart was stopped using drugs for an hour.
We Made a 2cm incision between cherie’s ribs on the right-hand side under the breast to access her mitral valve. It isn’t visible through the incision so, into a 2mm space between cherie’s ribs, we inserted a tiny camera. cords of Gore-tex, a thin but strong fabric, were stitched into place with a needle to replace the damaged tendons so the flaps
closed properly. We also had to reshape the ring of muscle that is attached to the valve flaps. Normally this ring resembles a capital D, but becomes circular when the flaps are damaged. By stitching in place a flexible ring of material, we can return it to a D-shape. repairing a valve is always better than replacing one. the heart doesn’t beat as well with a rigid mechanical valve, as it doesn’t give the same flexibility as natural tissue.
once the valve was repaired, we started cherie’s heart beating again. the incisions were closed with dissolvable stitches.
As with any surgery there are risks, such as bleeding — we give t he patient blood- t hinning drugs such as aspirin for three months afterwards to ensure there’s no clotting.
But keyhole surgery i t self reduces the risk of bleeding.
After the procedure we don’t need to give warfarin as, unlike when we use a mechanical valve, there is not a significant risk of a clot.
We hope more centres will adopt our approach. It represents a cost saving to the NHs, while patients like this approach because of the shorter recovery times and the fact they’re not left with an unsightly scar.
ANY DRAWBACKS?
THE only real drawbacks are the initial investment costs for the NHs, says Dr stephen Wheatcroft, consultant cardiologist at the Leeds teaching Hospitals NHs trust.
‘Performing both procedures at the same time requires a hybrid operating theatre/cardiac catheter laboratory.
‘ these are currently only available at certain hospitals and more i nvestment i s required before hybrid cardiac procedures can become routine practice across the UK.’
The essex Cardiothoracic Centre, call 01268 203 94190.