Sunday, July 12, 2009

New procedure removes need for open heart surgery

A pioneering procedure which removes the need for risky open heart surgery on patients with valve problems has been performed for the first time in Britain.

Surgeons can now repair leaking heart valves by passing a tiny 20cm long wire down the jugular vein, which sees patients discharged just a day after the operation.

Doctors at Papworth Hospital in Cambridge performed the first UK procedure last week, part of the Evolution II clinical research trial.
Led by Papworth's consultant cardiologist Dr Michael O'Sullivan, the procedure takes place while the patient is awake.

It is hoped that the process can cure mitral valve regurgitation, a condition which causes blood to wash backwards as weak heart valves fail to keep blood pumping in the right direction.

Dr O'Sullivan, who carried out the first procedure with his colleague Dr Peter Schofield, said the operation had huge potential.

He said: "This new approach is the first type of treatment of its kind in this country and is a brilliant, minimally invasive way of helping patients with leaking valves.

"Whilst it must be emphasised that this is a new technique, and will not be suitable for everyone, the early results with this device have been very promising.

"While open-heart surgery is still effective it does have its risks and puts you out of operation for months – with this we can have you back on your feet the next day."

The procedure works by passing the metal device, made of nitinol, a metal that changes size at body temperature, through a five millimetre incision in the neck.

The nitinol device, known as a MONARC, is then passed down the jugular vein into the coronary sinus, a vein that runs around the surface of the heart and around the valve. Once in position the device, consisting of two metal anchors which hold it in place and separated by a bridge, is designed to gradually shorten as it changes temperature in the body.

Doctors say that after a period of six weeks the metal will gradually contract, slowly reshaping the valve, stopping blood leakage – and after two years making the valve as good as new.

Leaking heart valves are a common problem for three per cent of the adult population in the UK and are commonly caused by high blood pressure.

The valve defect known as mitral valve regurgitation occurs when the valves which keep blood flowing through the hearts chambers stop working properly.

If the valve does not close properly, it will allow blood to leak backwards and when this happened it is known as valve incompetence or regurgitation.

This can cause extra strain on the heart causing it to become increasingly less effective eventually leading to heart failure and even death.

Papworth is one of three centres in the UK taking part in this trial and the first patient, a gentleman from Norfolk, is responding well after returning home the following day.

Cathy Ross, a senior cardiac nurse at the British Heart Foundation said they welcomed the new procedure which could save thousands of lives.

She said: "Open heart surgery is complex and can put huge strain on the heart which is problematic because most people who need this operation are older people.

"Open heart basically involves stopping a heart and keeping it pumping on a machine which is very stressful and if this can alleviate that then it is only a good thing."

More than 30,000 people have heart surgery in the UK every year and 95 out of every 100 surgeries are without complications and are totally successful.

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