Joseph is a 92-year-old man who was critically unwell. He had two completely blocked arteries to the heart that could not be treated by keyhole technique (angioplasty). He also had a severely narrowed aortic valve and needed a new aortic valve.

Because of his advanced age, we tried to treat him by medicine but really he was profoundly short of breath, even when he was in bed. He was getting recurrent episodes of chest pain, going into heart failure, and dying in the most terrible way.

Six months prior, Joseph was previously totally independent and lived on his own.

We couldn’t undertake a traditional heart surgery for him because his aorta had so much calcium, you couldn’t clamp it.

This is when we adopted a heart team approach to solve his problems. We’ve been doing beating heart heart coronary heart surgery for many, many years and we’ve been doing trans-catheter valve surgery now for many years.

As a result, we were able to come up with a unique combination. We did off-pump bypass - a bypass where the aorta isn’t clamped and a surgeon’s able to put a bypass graft directly onto the heart while it is beating - and at the same time we put a keyhole heart valve in through the aorta.

We brought those two technologies together for a patient who’s now doing very, very well. The patient has gone back home and has gone back to living independently. He would be dead by now if he hadn’t had the procedure.

We’ve also recently just submitted that operation for publication and, to our knowledge, it’s never been described before.