3 in 1 keyhole op transforms lives of heart patients
THOUSANDS of patients who suffer from multiple lifethreatening heart problems are to be offered ‘three-in-one’ surgery – three major procedures carried out during a single keyhole operation.
The NHS breakthrough means people can avoid open-heart surgery, which carries a high risk of brain damage, stroke and sudden death, and will slash recovery time from several months to two to three weeks.
Instead of a large incision, the heart is accessed via a handful of small cuts. A high-tech camera guides surgeons’ intricate movements. The technique is being used to simultaneously perform heartbypass surgery, and also to repair two failing heart valves.
A heart bypass is often the ‘last hope’ operation, carried out on about 20,000 British patients a year who are at high risk of a heart attack due to cardiovascular disease (CVD), the medical term for blocked heart arteries. It involves taking a vein from another area of the body and attaching it above or below a blocked or damaged artery in the heart, restoring the circulation.
The heart and lungs are temporarily stopped and their function taken over by a machine while the surgeon performs the procedure.
But pausing the heart can lead to complications including blood clots in the brain, stroke, kidney failure and even death. It also involves a foot-long cut in the patient’s breast bone and peeling back of the ribs to reach the heart.
CVD can also lead to damage to and leaking of the valves that act as gateways between the chambers of the heart. This means blood can pool inside the heart or escape from the heart entirely, leaking into the surrounding chest cavity, leading to pain and breathlessness and increasing the risk of stroke.
The estimated 1,000 patients each year who develop both problems normally require two separate operations, which can take a huge toll on the body of someone who is already frail. Now, patients can have two heart valves repaired, and a heart bypass, in a single two-hour operation.
The procedure, carried out under general anaesthetic, is split into two parts. First, two incisions are made on the left side of the chest. One 2in cut makes room for the camera, which is held in place by a flexible robotic arm.
Images are beamed to three 32in screens positioned in a semi-circle around the surgeon, giving him a highly detailed view of the heart. Through the other incision, less than an inch long, instruments take hold of a ‘healthy’ artery in the chest, behind the breast bone. A 6in section of this artery is removed and its ends stitched up. It is then grafted into the heart, above the blocked artery, redirecting blood flow. Next, the heart valves are repaired using a heartbypass machine which stops the heart for just ten minutes – compared to 30 in current operations.
The heart is accessed through another 2in incision in the right side of the chest. Tiny stitches are used to repair the valves and the heart is restarted. An ultrasound scan confirms the organ is correctly functioning before all the incisions are closed up.
Patients remain in hospital for about five days and can work, lift heavy objects and drive within two or three weeks.
Retired double-glazing company owner Vivian Ellis, 69, was one of the first to undergo the pioneering heart procedure. He needed two leaking valves repaired, and a bypass to combat blocked arteries.
‘I started to notice when I was left out of puff helping to move my daughter into a third-floor flat,’ he says. ‘Soon I began to get breathless when walking.’
In July, Mr Ellis, from Holmer Green, Buckinghamshire, was referred to Mr Toufan Bahrami, leading cardiac surgeon at The Royal Brompton and Harefield NHS Foundation Trust, where the new technique is being pioneered.
Mr Ellis said: ‘I was out of hospital in a week with very little pain and felt like I’d made a full recovery just two weeks afterwards.
‘A month after the operation, you could hardly see the incision holes. Now you would struggle to find them at all.’