TRADITIONAL AND INNOVATIVE PROCEDURES

The two common, life threatening problems with heart valves in adults are a narrowing of the aortic valve, called aortic stenosis, and mitral regurgitation.

Aortic stenosis typically occurs in people older than 65 years of age and involves progressive calcification of the leaflets of the aortic heart valve, restricting their opening when the heart contracts. This in turn causes decreased blood flow to the coronary arteries and to the body as a whole. As aortic stenosis becomes severe, patients may experience shortness of breath (as the heart cannot pump enough blood out to meet oxygen demand), chest discomfort or angina (caused by insufficient blood supply to the heart muscle) and may briefly lose consciousness.

Mitral regurgitation is when the two leaflets of the mitral valve don’t close correctly and blood leaks backward with each heartbeat. Because of this, the heart has to pump more blood with each beat to push the same amount forward. If left untreated for a period of time, the heart may begin to fail and patients may begin to show symptoms of shortness of breath or tiredness.

A lot of patients are incredibly well and have a single problem that is typically a narrow aortic valve or coronary artery disease. These people are eminently suitable for traditional open heart surgery from which they get an excellent result.

However, there are a growing number of patients with other significant medical conditions that may preclude them from having open heart surgery safely with a meaningful recovery to independent life.

For these people, open heart surgery - a highly invasive procedure that requires opening of chest - is needed to repair or replace that valve. This type of operation requires a general anaesthetic can cause serious complications with the heart, lungs, brain, kidneys and liver, particularly in older people, and can possibly lead to death. 

For these reasons, less invasive ways of treating mitral regurgitation and aortic stenosis are being developed.

For instance, through a little vein in the groin, we can now apply something that is a bit like a clothing peg to clip exactly where the valve leaflets don’t meet. This keyhole procedure, called Mitral Clip, reduces the mitral valve leak significantly but is associated with much less risk than conventional surgery.

Another procedure is transcatheter aortic valve implantation (TAVI). TAVI is a revolutionary procedure that allows us to replace the aortic valve without open heart surgery. This is where a heart valve that is crimped into a catheter is introduced through the artery in the groin (femoral artery) and then positioned in the diseased aortic valve. The new transcatheter aortic valve expands to fit within the diseased valve. The diseased aortic valve will not be cut or removed. The new valve will start to function immediately. For patients whose femoral arteries are too small to accommodate the new valve, we often introduce the trans-catheter valve between the ribs, across the apex of the heart – this is called a transapical approach. We have had no mortality on these transapical procedures and these results are world-leading. 

The Sydney Heart Team is able to assess the patients who are most suitable for having traditional open heart surgical techniques or having the trans-catheter techniques. It’s why both of the outcomes we have with open heart surgery and trans-catheter heart surgery are extremely good.