Wednesday, January 31, 2007

Doctors replace heart valve using keyhole surgery

An operation to replace a heart valve using keyhole surgery has been carried out in Leicester.

Gladys Adams, 89, underwent the procedure, yesterday at Glenfield hospital, a specialist cardiac centre. The technique avoids the need for open heart surgery and halves recovery times for patients.

The consultant surgeon, Jan Kovac, said: "In the past, patients would have been in hospital for at least a week after their operation. This new catheter treatment is much quicker and - in most cases - patients will be back home within a few days."

Ms Adams, from Wigston, had other medical complications that meant she was unsuitable for open heart surgery. The keyhole operation was the only option available to her.

The procedure, which is carried out while the heart is still beating, involves inserting a catheter into a vein in the groin from where it is threaded to the narrowed section of the aorta, the main blood vessel carrying oxygenated blood from the heart. The artificial valve is threaded through the catheter and expanded to fix it in position.

Called percutaneous [through the skin] heart valve replacement, it is similar to that for angioplasty, in which a narrowed section of coronary artery is expanded by the insertion of tiny balloon.

Normally, it requires only a local anaesthetic as the catheter is threaded into the vein in the groin. Using a special imaging technique, the new valve is guided through the catheter to the existing aortic valve, which was malfunctioning.

Replacement valves are taken from the hearts of horses, pigs or cows, which are sterilised and stitched into a metal frame. That is compressed to the thickness of a pencil so it can be threaded through the catheter and then expanded by inflating a tiny balloon once it is in place. The existing valve is pushed aside by a device anchored inside the valve opening.

The operation was originally billed by Glenfield Hospital as the first keyhole replacement surgery in Britain for any heart valve.

But the British Heart Foundation says a similar procedure involving a different heart valve - the pulmonary valves of children - was introduced in this country five years ago.

Professor Peter Weissberg, medical director of the foundation, said: "We're very pleased to see this technology now being used more widely in the UK to treat elderly people with life-threatening aortic heart-valve disease."

Heart valve replacement is the second most common cardiac operation carried out at Glenfield after coronary bypass surgery.

The valves are essential to controlling the direction of blood flow in the heart. They can malfunction in two ways: either they do not open completely, causing stenosis, which means the heart has to work harder to pump the blood through, or they do not close completely, causing regurgitation, when the blood flows backwards.

Stenosis can lead to heart failure while regurgitation increases the amount of blood in the heart, raising the pressure and also risking heart failure.

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