Africa’s first Structural Heart Surgery Centre, specialising in the percutaneous repair of leaking heart valves and various other cardiac anatomical abnormalities by means of minimally invasive surgery, has been established at Netcare Union Hospital in Alberton, Johannesburg.
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Dr Farouk Mamdoo, a cardiologist who practises at the hospital, says that it is not widely known, even within the medical profession, that heart valves can be successfully repaired percutaneously (through a small puncture in the groin) in this country. In fact, Dr Mamdoo and fellow cardiologist, Dr Chris Zambakides who also practices at Netcare Union Hospital, have both undergone training overseas in this technique and have had a 100% success rate since they did the first procedure at Netcare Union Hospital three years ago.
“We have identified a great need for a structural heart centre in South Arica. Unfortunately there are no other practitioners in the private sector in this country who are trained to do this procedure, which offer many advantages over traditional open-heart valve repair surgery and can be life saving for certain patients,” observes Dr Mamdoo.
Lower risk alternative
“Patients with heart valve, or paravalvular, leaks often require repeated open-heart surgery, as the repairs to severely diseased heart valves can deteriorate over time. This type of surgery may be risky, especially when patients are weakened and in poor health. On the other hand, the percutaneous repair of a leak, which involves just one small puncture wound, is much less invasive and a lower risk alternative than open-heart surgery.
An important benefit of the percutaneous procedure is that the repair itself is permanent and does not deteriorate, eliminating the need for repeat repairs in future,” explains Dr Mamdoo.
Dr Zambakides agrees, pointing out that in a percutaneous repair of a leak the patient is given a mild anaesthetic, recovers from the procedure quickly and is usually discharged within a couple of days. The fact that the patient’s hospital stay is shorter makes this a highly cost-effective option for patients.
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“Using advanced 3D imaging, specifically live 3D trans oesophageal echocardiography, we are able to visualise in three dimensions the heart chambers and the damaged valve, and guide the procedure to repair it with great precision.”
“The repair is done through a small puncture in the groin into which a guide wire with a catheter attached is advanced. Through this catheter a plug is delivered to the site of the valve leak. The plug has a wing on either side with a neck in the middle. The neck is deployed into the leaking hole and closes it, with the wings anchoring the plug in position. Heart tissue then grows over the plug and it becomes part of the body,” says Dr Zambakides.
Greatly improved quality of life
Dr Mamdoo says the fact that the percutaneous procedure is minimally invasive means that certain patients whose lives depend on having valve repair, but are in such poor health that they would not survive normal open surgery, can be successfully treated.
Drs Mamdoo and Zambakides for example recently performed percutaneous valve repair on a 45-year-old male patient who was referred to them by a cardiologist at Netcare St Augustine’s Hospital in Durban, as the man’s condition was too compromised for him to undergo traditional open surgery. The patient is doing very well and enjoying greatly improved quality of life.
Dr Mamdoo adds that some severely compromised heart patients are not in a condition to travel. While the structural heart centre is based at Netcare Union Hospital and most procedures will be undertaken there, the team is prepared to travel to treat patients at other hospitals if they are too weak to travel to the centre in Alberton for the procedure.
They are able to perform procedures at any hospital that has a hybrid theatre with 3D imaging technology, such as the one at Netcare Christiaan Barnard Memorial Hospital in Cape Town or the one being developed at Netcare St Augustine’s Hospital in Durban. “We believe that this miracle procedure should be made available to as many South Africans as possible and will work with a patient’s cardiologist to achieve the very best outcomes,” adds Dr Mamdoo.
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According to Dr Zambakides, replacement of diseased heart valves with an artificial heart valve is commonly done at many medical facilities in South Africa. Between 3% and 6% of patients who have artificial heart valves will at some stage develop a leak between the artificial valve and the surrounding tissue which is often not serious enough to require treatment.
In a few cases, however, the blood leak is more substantial, which may place strain on the heart and could cause heart failure. Such leaks are life threatening and require repairing. In some cases it may be important to identify and repair a leak early as this can prevent further deterioration of the valves and prevent further leaks from developing.
Cutting edge procedure
“Rheumatic heart disease, which can severely damage the heart valves, is being successfully combated in South Africa today, but was a fairly common childhood disease a few years ago. Many sufferers of the condition had to have their heart valves replaced with a prosthetic mechanical heart valve. For those individuals who in time develop a heart valve leak, a timeous percutaneous repair can literally give them back their lives,” observes Dr Mamdoo.
Dr Zambakides says the first successful paravalvular closure was performed by the two cardiologists at Chris Hani Baragwanath Hospital in 2011. However, a lack of training in the technology has prevented the wider use of the procedure in South Africa.
Dr Mamdoo and Dr Zambakides believe that it is important for more cardiologists to become familiar with this cutting edge procedure and its associated technology. The two cardiologists, who are fully accredited to perform this procedure, therefore intend to use the new Structural Heart Centre at Netcare Union Hospital to train interested doctors in the surgical technique.”
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In addition to heart valve repair, the new dedicated centre also offers percutaneous aortic valve replacement, closure of congenital or traumatic heart defects, balloon dilatation of stenotic, or diseased, valves and closure of atrial appendage (a small sac in the muscle wall of the left atrium of the heart) for stroke prevention in appropriate patients. Read more:
With links to the University of the Witwatersrand Medical School and the Cardiology Unit at university teaching hospitals such as Chris Hani Baragwanath Hospital, the team at Netcare Union Hospital are involved in hosting workshops and training programmes with international recognition to broaden the expertise of these specialised skills.
Barry Bedford, Regional Director – Gauteng South West of Netcare’s Hospital division says the cardiac unit at the hospital offers a range of cutting edge cardiac services thanks to the ground-breaking work of cardiologists such as Dr Zambakides and Dr Mamdoo, as well as the state-of-the-art equipment at the facility.
“We are privileged to work with such outstanding medical practitioners, and applaud their willingness to make their skills available on a wider scale so that as many as possible South Africans could benefit from this procedure.”
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Image: Heart surgery from Shutterstock