IN A MAJOR breakthrough in the treatment of heart disease in the Republic, for the first time a patient here has had a heart valve replaced without the need for open-heart surgery.
Two patients in their 80s had replacement aortic valves placed inside their hearts using a new form of keyhole surgery.
The groundbreaking procedures, each of which took two hours to perform, were carried out at the Blackrock Clinic, Dublin, last Wednesday.
Both patients are recovering well after a team of 25 health professionals used a compressed replacement valve passed into the body via a catheter in the main leg artery to replace the diseased part of the heart.
Led by Dr Martin Quinn, consultant cardiologist at St Vincent's Hospital and the Blackrock Clinic, and Dr Peter Crean, consultant cardiologist at St James's Hospital and the Blackrock Clinic, the team, which also included cardiac and vascular surgeons, operated on the two patients who would have been unlikely to survive open-heart surgery.
One, an 84-year-old man, had been unable to leave hospital for 3½ months such was the severity of breathlessness brought on by severe aortic stenosis. This disease means the opening through which blood can pass from the heart into the body's main artery (the aorta) is narrowed considerably, leading to breathlessness, chest pain and sudden loss of consciousness (see panel).
The second patient, a woman aged 88, while less severely ill, was also suffering the effects of a critically diseased aortic valve. According to medical sources, she has recovered quickly and is looking forward to returning home to a more active and independent life.
Neither of the patients was considered suitable for traditional open-heart surgery - without the new procedure, both faced a 50 per cent risk of dying from heart disease in the next year.
The procedure involves placing the new valve, which is made from bovine tissue, into the patient's existing valve. A balloon is then inserted into the new valve and inflated until it pushes the existing valve's tissue flaps against the wall of the aorta. The balloon is then removed and the new valve starts to work immediately.
The 26mm replacement valve was recently licensed for use in Europe. It is manufactured by Edwards LifeSciences, a company specialising in heart-valve replacement.
Dr Crean and Dr Quinn prepared for last week's operations for six months, including time spent training in Germany.
The new device has a restricted licence: the recipient must have symptomatic and severe aortic stenosis and, when assessed for open-heart surgery, must have a greater than 20 per cent chance of dying.
The groundbreaking approach means that older and sicker people can now be offered life-saving treatment. The cost of the procedure at the Blackrock Clinic is covered by the VHI. Each valve costs €23,000.
Sources said they expect the technique will be soon available to public patients.
Welcoming the breakthrough, Bryan Harty, chief executive of the Blackrock Clinic, said: "I am very pleased that Blackrock Clinic has been able to introduce this technique to Ireland."
Dr Quinn said last night: "This is an amazing procedure that is far less traumatic than conventional surgery for high-risk patients."
Dr Crean said he expected both patients would be more mobile and have a better quality of life.
Experience across Europe suggests that some 96 per cent of patients survive the procedure.
WHAT IS AORTIC STENOSIS?
THE AORTIC valve controls the flow of blood from the heart into the large artery that brings blood to most of the body. When healthy, it opens and closes in tandem with the beat of the heart.
However, the aortic valve (and other heart valves) may become diseased.
In aortic stenosis, the valve becomes fixed in place and the opening through which blood can pass through is narrowed considerably, leading to a significant back pressure on the main chamber of the heart, the left ventricle.
In the past, congenital anomalies and the after-effects of rheumatic fever were the most common causes of aortic stenosis. Now, the most frequent cause of the heart-valve problem in adults is an age-related calcification.
When examined under a microscope, the calcified valves often show inflammatory changes similar to those seen in blood vessels blocked by fatty material (atherosclerosis).
The stenosed aortic valve causes the muscle of the left ventricle to thicken in an attempt to overcome the obstruction to the flow of blood caused by the faulty valve.
Eventually this leads to heart failure.
The main symptoms of aortic stenosis are shortness of breath, chest pain (angina) and fainting during exercise.
Patients with the disease are also prone to developing a rhythm disturbance of the heart.
When a doctor examines a patient with aortic stenosis, he or she will hear a characteristic heart murmur. Investigations including an ECG and an echocardiogram (an ultrasound of the heart) usually confirm the diagnosis.
The definitive treatment for the problem is to replace the valve during open heart surgery. This remains the treatment of choice for most people.
However, older patients with severe aortic stenosis and other medical problems affecting the lungs and kidneys may not be able to tolerate the trauma of major heart surgery.
These are the people who will benefit from this breakthrough treatment, whereby the valves can be replaced using a similar approach to that used for the insertion of stents into diseased coronary arteries.
DR MUIRIS HOUSTON