Saved from death’s door by surgery on still beating heart
ABREAKTHROUGH device is allowing NHS s urgeons to mend failing heart valves with a series of tiny stitches inserted while the heart still beats – saving the lives of people deemed too frail for open-heart surgery.
At present, sick patients can be denied the standard valve-repair operation because it requires a heart bypass – when the heart is temporarily stopped – and they are too ill to cope.
The new treatment uses a handheld gadget that can be inserted into the live heart to fix the fault.
Open- heart surgery i nvolves making a incision down the patient’s chest and splitting the breastbone. But with the new NeoChord device, doctors can access and repair tiny heart valves – which keep blood flowing through the heart in the right direction – through just a 2in cut. This means recovery time is slashed from a week to about three days in hospital.
Surgeons at the Royal Brompton Hospital in London have so far successfully treated 17 seriously ill patients, who could not safely undergo standard surgery, with the device. But they believe the treatment could one day offer an alternative way to repair leaky valves in a wider group of patients.
‘The patient has a shorter hospital stay, they have a faster recovery and they don’t have a big cut in their breastbone,’ said Rashmi Yadav, consultant cardiac surgeon at the Royal Brompton. ‘However, the biggest advantage of this procedure is that the valve is repaired on the beating heart and the patient
does not have any of the side effects of having their heart stopped.’
Robert Taunton, 81, from Littlehampton in West Sussex, was barely able to move before undergoing the procedure in January. Having previously had a triple heart bypass, he was not suitable for standard surgery. ‘I thought that my time was up,’ he said. ‘But almost immediately after the operation I could walk again and now I can drive, go fishing and even play table tennis. I’m amazed by the difference.’
Heart-valve disease affects about 1.5 million people over 65 in the UK. It can affect the mitral valve, a small flap that separates the upperleft chamber of the heart from the lower-left chamber and stops blood flowing the wrong way. If the valve stops working properly, it can cause blood to leak backwards towards the lungs. This commonly occurs when the cords attached to the edges of the flap become thin, too long, or break. ‘The cords are a bit like the strings of a parachute,’ Ms Yadav said. ‘If they break, then blood flows towards the lungs every time the heart squeezes.’
As a result, the heart works harder to compensate for blood going the wrong way, causing symptoms such as shortness of breath and palpitations. The conditi on can eventually l ead to heart failure.
During open-heart surgery the heart is stopped, the patient is placed on a heart- lung bypass machine and the surgeon opens up the organ. It’s the standard treatment offered to repair the fault but for frail patients there is a risk that their heart may become too weak to work properly afterwards.
The NeoChord procedure offers a new option. Patients are put under general anaesthetic for the procedure, which generally takes up to two hours.
Firstly, a cut about 2in long is made on the left side of the chest, underneath the nipple.
The surgeon then goes in between the ribs to access the heart, without spreading them. A tiny incision is made in the apex of the heart – the bottom left part of the organ – and the NeoChord device is rotated in, gently creating a small hole.
The surgeon uses ultrasound images to navigate the heart and reach the leaking valve without causing damage.
The end of the NeoChord device is opened to grasp the loose part of the mitral valve, and a needle in the tool attaches new artificial cords to the flap.
The surgeon is left with four or five strings, coming out of the hole in the heart, which they can adjust to the right length to create tension and stop the leaking. These are tied off and the hole stitched up.
Mr Taunton, who has two sons and four grandchildren, suffered deteriorating health for more than a year before he was operated on. By this time, fluid had built up in his legs as a result of his leaking mitral valve, causing him to put on almost three-and-a-half stone in weight. ‘His legs were like lead,’ said his wife Carol, 79. ‘They were filled with liquid and looked like elephant legs.’
Mr Taunton took just five days to recover from his procedure and his wife says his improvement since has been ‘unbelievable’.
The Royal Brompton Hospital is currently the only centre in England, Scotland and Wales to offer the procedure. A trial giving patients the option of NeoChord and conventional surgery is expected to begin soon.