Aga Khan doctors in heart surgery breakthrough
Specialists at the Aga Khan University Hospital have performed the first heart valve replacement in the region using a novel technique that uses only two punctures in the groin.
The operation has been hailed as a landmark procedure for the region, which removes the need for open heart surgery to enable the valve replacement.
The new technique of trans-catheter aortic valve implantation (known as TAVI) is only available in a few specialist centers around the world and requires a comprehensive team with experts who have internationally recognized experience in both open surgical and minimally invasive interventional techniques.
The Aga Khan University Hospital Heart and Cancer center is the only center in sub-Saharan Africa outside South Africa which has met with international approval for this technology to be made available.
Dr Mohamed Jeilan, who led the team that performed the procedure, emphasized the importance of an integrated and highly skilled team of specialists including cardiologists, heart anesthetists, cardiac surgeons and specialist nurses.
This technique was approved for use in the USA only as recently as 2013.
Many leading world experts have described this new technique as the most important breakthrough in cardiology in the last twenty years.
Doctors treating the patient at Aga Khan University Hospital in Nairobi had discovered a critical narrowing of the main heart valve (aortic valve), which is the main valve through which all blood is pumped from the heart.
The patient had complained of difficulty in breathing and easy fatigue. This condition (aortic stenosis) is caused by rheumatic fever in younger patients, or by progressive valve degeneration in older patients. It can only be treated by replacing the old valve.
The condition is progressive and if left untreated results in death within six months of the onset of symptoms in up to half of patients.
Unfortunately many patients present at an advanced stage, or when they are too ill, or frail to have the open heart surgery.
The new technique of trans-catheter aortic valve implantation (TAVI) allows the valve to be replaced using just two, or three punctures in the groin and without the need for an open heart operation.
Using this technique, the heart specialists prepare the replacement valve which is then delivered through the groin backwards across the old narrowed valve.
Using advanced x-ray techniques, the specialists remove the sheath, and slowly expand the new valve into position and within minutes it is able to function normally and takes over the function of the old valve. The whole procedure takes between one and two hours.
“The main advantage of this technique is that it is less invasive and is associated with a faster recovery in most cases with patients able to get back to normal functioning much earlier. It is currently recommended for patients who, after review by a heart surgeon, are considered at high risk of an open operation”, said Dr Jeilan.
The operation, like most heart operations, carries some risks. These include damage to the vessels in the leg, and a surgeon who is an expert in treating the leg arteries is usually needed to be on stand-by.
In a small number of cases, a new heart pacemaker is needed because of the position of the heart’s natural pacemaker which is very near to the heart valve.
There is also a small risk of a stroke, a heart attack, or even death.
Because of the stringent requirements for approval to introduce this technology at any unit, it is only available in a small number of centres around the world.
The availability of this treatment locally emphasizes the significant strides that the Aga Khan University Hospital Heart and Cancer Centre has taken to enhance its reputation as a leading and world class centre for heart patients.