10:24am Friday 11th December 2009
Elderly patients in the region are getting a new lease of life thanks to a pioneering new way of replacing narrowed heart valves. Health Editor Barry Nelson investigates.
ANEW method of tackling a serious heart condition has arrived in the North- East. It promises to transform the experience of scores of elderly heart patients, dramatically cutting the amount of time they need to spend in hospital and improving their quality of life.
Already around 16 North-East patients have undergone the procedure to treat a condition called aortic stenosis. This is when the main valve which allows blood to flow from the heart around the body has become narrowed. This can cause chest pain, discomfort, breathlessness, blackouts and – if untreated – life-threatening heart failure.
Heart specialists at the Freeman Hospital, in Newcastle, treated 12 patients earlier this year and now heart specialists at The James Cook University Hospital, Middlesbrough, have carried out another four.
Instead of undergoing major openheart surgery, which involves cutting through the breastbone and stopping and re-starting the patient’s heart, a lengthy stay in hospital, followed by six months recuperation, patients are being fitted with new heart valves via a small incision in their groin or chest and allowed home within a few days.
First performed by heart specialists in France in 2002, the procedure – known as a Transcatheter Aortic Valve Replacement, or Tavi – has gradually spread around the world.
Heart specialists in Leicester carried out the first UK Tavi procedure a couple of years ago and this year, teams of doctors at the North-East’s two specialist heart hospitals were given Tavi training.
Using advanced scanning techniques, specialist doctors insert a thin tube, or catheter, into a small incision in the groin or chest and feed this up the arterial system to where the artery has become narrow.
A tiny balloon is then fed up the catheter to the blockage and inflated to stretch the narrowed valve. After this, the new valve is inserted and expanded by another balloon. When the balloon is deflated, the new valve is held in place by the surrounding tissues.
There is no need to stop the beating heart and if all goes well, patients can often be conscious and talking within a few hours of the procedure and go home within a few days.
“This has been developed for the treatment of arterial stenosis, or narrowing of the arteries,” says Dr Ian Purcell, a consultant cardiologist at the Freeman Hospital. “It can give patients extremely severe symptoms, angina, heart failure or even sudden death. It is a very common condition in elderly people.”
The new procedure was developed as a way of providing a gentler, alternative to opening up the patient’s chest, stopping their heart and inserting a new artificial heart valve, according to Dr Purcell.
“The majority of patients who have this condition are over 65. The conventional way of treating this is very good, but is not suitable for someone who may be old and frail. Because of this, about 30 to 40 per cent of patients who need treatment for arterial stenosis are not having surgery at all,” he adds.
SINCE the Tavi programme started several months ago, the cardiologist and his colleagues have carried out 12 successful procedures.
“Primary Care Trusts in the north and south of the region have now agreed to fund more Tavi procedures.
We probably need to be doing more than 20 a year,” he says.
Dr Douglas Muir, a consultant interventionist cardiologist at James Cook, says that since the Tavi programme started they have performed four and are due to complete eight by next week.
He points out that in a typical Tavi procedure, up to eight consultants – two cardiologists, two surgeons, two anaesthetists and two radiographers – are involved.
“A CT scan is done before the procedure to check the arteries and the patient is continually scanned using ultrasound throughout the procedure,”
says Dr Muir. “Tavi procedures require a lot of expertise. Our whole team, eight people in all, recently spent some time in Leipzig, in Germany, as part of our training. The Germans have already done quite a few of these procedures. We also had two consultants come up from London to assist us for the first cases.”
The Middlesbrough consultant says the average age of the patients treated so far is around 89.
“Aortic stenosis is very much a disease of age and we expect to see a mixture of men and women,” he says.
The first to have the new procedure at James Cook was 88-year-old Tommy Graham, from Darlington. A retired insurance supervisor, Mr Graham’s health was deteriorating because of a narrowed heart valve.
Following his successful Tavi operation, Mr Graham was talking within a few hours and back at home within four days. His daughter, Alison Billau, who is a specialist community heart nurse in Darlington, remembers how ill he was before the operation.
“He was deteriorating and getting frail. He was quite lethargic, short of breath and had no energy.”
Alison was amazed at how quickly her father recovered after the operation.
“The traditional way of doing this means you take six months to recover.
With this new approach my dad was only in hospital for about four days,” she says.
Dr Muir was also impressed by Mr Graham’s progress. “He made a remarkable recovery,” he says. “He was up and talking within three hours and back on the ward that same evening.
He looking really good, as if nothing had happened.”
He confirms that “substantial funding”
had been secured from local primary care trusts to enable more Tavi procedures to be carried out in future.
“We know that if patients with this condition are not treated they become more breathless and more limited in what they can do. Although Tavi is a new technique, we already know that it improves the quality of life for patients.”
Dr Muir stresses that for younger, fitter patients with aortic stenosis, conventional open-heart surgery is an “excellent” treatment. “The problem with many older patients is that they are either too ill, too frail or have other problems which stop them having this form of surgery.”
Mr Graham is certainly grateful: “I just want to thank the incredibly professional team at James Cook for what they have done for me. I am very proud of the local community heart service.”
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