Medical history was made this week when the first transcatheter aortic valvular implantation (TAVI) heart procedures in South Africa were completed.
In the next few days, a total of eleven TAVI procedures will be done in Johannesburg, Durban and Cape Town as part of a training programme led by world-renowned cardiologists and surgeons. The procedures have been given the full backing of the South African Society of Cardiovascular Intervention (SASCI) - a working group of the South African Heart Association.
For those who have severe aortic heart valve stenosis (narrowing) and who will not be able to survive open-heart surgery, there has been little to do except wait to die. The groundbreaking heart procedures were successfully completed on three such patients at the Netcare Sunninghill Hospital in Johannesburg over the course of Monday and Tuesday. The patients are all doing well according to hospital authorities.
The three operations were the first of their kind in Africa, and give new hope to those who don't qualify for open-chest heart surgery, according to Johannesburg team leader Dr Farrel Hellig, a cardiologist from the Netcare Sunninghill Hospital who is also the Vice President of SASCI.
He explains that there are several reasons why a patient may not be suitable for open-heart surgery. Patients may have co-morbid conditions (other medical conditions occurring together with the diseased valve) that preclude open-heart surgery. Patients may be in such a frail condition as to not be able to survive the anaesthetic necessary for the surgery, or the open-heart procedure itself.
The TAVI procedure is a breakthrough in South African medical science, says Dr Hellig. The procedure, which involves doctors using tubes known as catheters to implant a device to replace a diseased heart valve, can considerably improve the quality of life of patients as well as give them many more years of life. The device used, which is known as the transcatheter aortic heart valve, and manufactured by international medical equipment manufacturer Edward Lifesciences, is "a little miracle", according to Dr Hellig.
"The transcatheter heart valve procedure is far less invasive than traditional open-heart surgery," continues Dr Hellig. "In other words, the new approach makes it possible to repair the heart valve without having to resort to traumatic chest opening surgery. Seriously ill patients are therefore more likely to survive the procedure. Patients also often recover relatively quickly; some are up and about within days."
Jacques du Plessis, Managing Director of Netcare's hospital division, says: "As patient recovery times tend to be quicker with improved outcomes, the TAVI can result in some savings. For example, patients are in hospital for a shorter duration than they're likely to be after open-heart surgery."
"The four elderly Johannesburg patients, two of whom are male and two females, suffered severe aortic disease and were 'very ill'," says Du Plessis.
Apart from Dr Hellig, the team included renowned cardiologist and president of SASCI, Dr Graham Cassel of Netcare Milpark Hospital, and cardio-thoracic surgeons Dr Jan Coetzee of Netcare Sunninghill and Dr Martin Sussman of Netcare Milpark Hospital. Echo cardiologist Dr Eric Klug was responsible for the ultrasound imagining. Du Plessis reports that the operations were a resounding success and that the patients are recovering well.
(Martina Nicholson Associates, October 2009)