Alternative To Open Heart Surgery Emerges Following Nihr Research
Less invasive procedure offers an equally effective alternative for heart condition patients
Researchers at the National Institute for Health and Care Research Leicester Biomedical Research Centre have shown that a less invasive heart procedure for a common condition is just as effective as conventional open-heart surgery.
The study compared Transcatheter Aortic Valve Implantation to conventional surgery while treating severe symptomatic aortic stenosis.
It is the first publicly-funded research of its kind and involved every centre in the UK that performs TAVI a procedure in which a new valve is threaded through a small tube inserted into an artery in the groin, upper arm, or chest.
Professor William Toff, Professor of Cardiology at the University of Leicesters Department of Cardiovascular Sciences, led the UK TAVI study. He explained: Its great news for patients that TAVI is just as safe and effective as surgery even in patients at lower operative risk. This procedure is much less invasive than conventional approaches.
Patients with severe symptomatic aortic stenosis suffer a narrowing of the valve that blood flows through as it leaves the heart. Treatment often requires surgery and the condition is associated with a poor prognosis, with most patients dying two to three years after diagnosis. Symptoms include shortness of breath and fatigue and can become life-threatening.
It is estimated that 1.5% of UK adults over 55, and 3.5% of those over 75, have the condition.
Alternative To Bypass Surgery
Angioplasty and bypass surgery are the two prime options given to the patient when heart blockages are detected in one or all the three major arteries of the heart. Patient has complaints of chest pain breathlessness on walking heaviness in chest etc. EECP is a non-invasive treatment which can be offered as an alternative to angioplasty and alternative to bypass surgery.
What happens in EECP can be understood only when patient knows what happens in treatment like angioplasty and bypass surgery. In angioplasty a stent in inserted in the blocked artery. In bypass surgery a small part of a blood vessel is taken from either hand or leg and a bypass route is created for blood to flow in the area affected by the blocked artery. The blockage remains the same, just an alternative route is created for blood supply to resume in affected region of the heart.
EECP is a non-invasive procedure. Its an hour long procedure and treatment duration is 35 sessions of EECP. The treatment is conducted by applying three electrodes through which the ECG is read on the EECP machine. Accordingly to the patients heart beat three cuff tied to patients leg inflate and deflate in diastole and systole of the heart respectively. EECP benefits patient complaints by activating the collateral circulation i.e. small arteries and establishing myocardial blood flow. So if there is blockage in the left side of the heart, blood supply will be maintained from the right side through collateral circulation.
How Can Keyhole Heart Surgery Help Me
Discovering that you have a heart condition or that you need open-heart surgery is an unnerving experience. Mr Birdi and the team at the Keyhole Heart Clinic can offer professional advice at every step of your journey. If you have been diagnosed with a heart condition and have been told that you need open heart surgery, we can provide a complete overview of your options.
To know more about how our service works .
Our specialist team can also offer advice for those who have yet to receive a diagnosis but are worried about their heart health. If youre experiencing symptoms or you have a family history of heart conditions, we can provide an insight into your current help and the next steps to be taken, if necessary. We can also offer a second opinion on your heart condition and treatment. Receiving news about your heart health will understandably leave you with a lot of questions. Our specialist team will help you understand the full scope of your condition and the options you have available.
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Alternative To Open Heart Surgery Just As Effective For Patients With Common Heart Condition
A study led by researchers at the National Institute for Health and Care Research Leicester Biomedical Research Centre has shown that a less invasive heart procedure for a common condition is just as effective as conventional open-heart surgery. The findings are published in the Journal of the American Medical Association today .
The study compared Transcatheter Aortic Valve Implantation to conventional surgery in treating severe symptomatic aortic stenosis. In this condition there is a narrowing of the valve that blood flows through as it leaves the heart and treatment often requires surgery. It is estimated that 1.5% of UK adults over 55 and 3.5% of those over 75 have this condition.
The study is the first publicly funded study of its kind and involved every center in the UK that performs TAVI.
The first TAVI in the UK was performed in Leicester in 2007 by a multidisciplinary team at Glenfield Hospital in Leicester, led by Professor Jan Kovac. In a TAVI procedure, a new valve is threaded through a small tube inserted into an artery in the groin, upper arm or chest. It provides an alternative to open-heart surgery and is widely used across the UK.
Which Procedure Is Best
You may not always be able to choose between having a coronary angioplasty or a coronary artery bypass graft.
But if you are, it’s important to be aware of the advantages and disadvantages of each technique.
As a coronary angioplasty is minimally invasive, you’ll recover from the effects of the operation quicker than you will from a coronary artery bypass graft.
Coronary angioplasty usually has a smaller risk of complications, but there’s a chance you’ll need further treatment because the affected artery may narrow again.
But the number of people who need further treatment has fallen in recent years because of the use of special stents coated with medication that reduce the risk of the artery narrowing again.
See how a coronary angioplasty is performed for more information about these.
A coronary artery bypass graft has a longer recovery time than coronary angioplasty and a higher risk of complications.
There’s also some evidence to suggest that a coronary artery bypass graft is usually a more effective treatment option for people over 65 years of age, particularly for people with diabetes.
If possible, you should discuss the benefits and risks of both types of treatment with your cardiologist and cardiac surgeon before making a decision.
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Minimally Invasive Heart Surgery
At Stanford Health Care, our expert surgeons use a minimally invasive approach whenever possible. Our team has extensive experience and specialization with this advanced technique. If we can perform a heart procedure without open-heart surgery, we will do it.
When you come to Stanford for minimally invasive heart surgery, you benefit from:
- Experience from high volume: Whenever possible, we perform heart surgeries using a minimally invasive approach. That commitment means our surgeons have a superior level of experience and skill in these procedures.
- Advanced technology: Our cardiovascular surgeons use innovative, high-resolution imaging technology in the operating room. This advanced equipment sends incredibly detailed, 3-D images of the beating heart to your surgeon in real time, for the most precise results possible as we operate.
- Reputation: Our heart surgery program at Stanford is world-renowned for its pioneering work in a number of heart procedures: From the first adult heart transplant in the U.S., to the world’s first ventricular assist device. Now, were leading the way with new techniques for minimally invasive heart surgeries and applying this knowledge to some of the most complex cases.
Advisory: This brochure contains graphic images.
Heart Team Approach Enhances Patient Outcome
The surgeons and cardiologists at Lankenau Heart Institute work collaboratively to determine the best care for each patient. As such, Dr. Sutter consulted with his interventional cardiology colleague, , about the most appropriate care plan for Ann. They were able to offer her an innovative, hybrid approach that blends with coronary artery stenting to restore blood flow to the heart, without opening the chest.
Ann was excited. Dr. Sutter performed Ann’s robotic coronary bypass surgery using her healthy, left internal mammary artery to bypass the blockage and restore blood flow to the heart. Three days later, Dr. Caroline implanted stents in the other coronary arteries needing treatment to keep blood flowing. The next day, Ann went home.
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Patient Benefits Of Transcatheter Aortic Valve Replacement
Since TAVR is a faster and less invasive procedure, patients normally leave the operating room, spend a few hours in recovery, and then stay overnight in the hospital without the need for intensive care unit monitoring.
Its really benefitted our patients because they feel better quicker, says Dr. West. When we look at quality of life scores, patients indicate that they dont even realize they had the surgery a week later. It may take several months before we see those kinds of gains with open heart surgery.
What Happens During A Tavr Procedure
During the TAVR procedure, an artificial valve is implanted through a catheter, which is inserted through a large artery in the patients leg, eliminating the need for open-heart surgery and use of a heart lung machine.
The procedure only requires the use of local anesthesia. Many patients return home to recover within one to three days.
This allows the procedure to help those who might have smaller blood vessels. In addition, following the procedure, patients recover more quickly because it is a minimally invasive procedure.
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Coronary Artery Bypass Grafting
Coronary artery bypass grafting is performed with a small- incision approach, either through the center of the chest or through the side.
We tend to reserve this procedure for patients who need one or two bypass grafts, says Dr. Burns. Through a CABG, we bypass one or more blocked coronary arteries with a blood vessel graft to restore normal blood flow to the heart.
These grafts usually come from the patients own arteries and veins located in the chest, leg or arm.
CABG is performed by putting the graft around the blocked arteries to create new pathways for oxygen-rich blood to flow to your heart. The goals of the surgery are to relieve symptoms of coronary artery disease, allow you to return to a normal lifestyle and lower your risk of a heart attack or other heart problems.
The other good news is that while you will have a scar on your chest from the incision, and where the grafted blood vessels were taken from, the scars will gradually fade over time.
Itll take about two months to recover from CABG, he says. Your overall health and the outcome of the operation plays a big role in how youll feel after you get out of surgery.
Benefits Of Keyhole Heart Surgery
You may not realise that keyhole heart surgery is now a proven procedure and is very safe in expert hands. It is also known as minimally invasive or minimal access heart surgery. Mr Birdi and the team at The Keyhole Heart Clinic team been performing keyhole heart surgery for more that 17 years and are internationally recognised leaders. No clinical team has more experience in Keyhole Heart Surgery than Mr Birdi and his clinical team. We really are the Number 1 keyhole heart clinic service in the UK. With us you can rest assured that if keyhole heart surgery is suitable for you, then you can benefit from the many advantages listed below:
- You do not need to have your breastbone divided so you can heal in a few days rather than 3 months
- Your scar can be as small as 3 inches in length compared to 12 inches with traditional treatments
- Your scar can be concealed from view so you can wear what you want without concern
- Some keyhole treatments do not need any cuts at all and You can avoid open heart surgery completely
- Small scar with superior cosmetic appeal
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Who Can I Talk To About My Heart Condition
When youve been diagnosed with a cardiac condition, or youre concerned about your heart health, we can provide expert advice on the appropriate treatment and whether your heart condition can benefit from the keyhole approach to heart surgery. Our medical team have over 25 years experience in the treatment of heart disease, and each member is internationally recognised for their heart surgery and cardiology expertise. The clinical lead and director of our Keyhole Heart Clinic is Mr Inderpaul Birdi, renowned as one of the best heart surgeons in the world, has 17 years experience in minimally invasive heart surgery. Please contact us if you would like to learn more about our team and our services.
How Do I Manage Post
A cardiac anesthesiologist is also a pain management specialist for conditions related to surgery. Your anesthesiologist will talk to you about your options for managing post-operative pain. Before your surgery, the anesthesiologist may ask about your pain tolerance to help gauge how best to manage your post-operative pain, guiding decisions such as the proper narcotics dosage, the feasibility of nonnarcotic pain medication options, and the need for nerve blocks.
Although most heart surgeries are major surgeries, they are typically not a source of long-term pain. Even in the short term, the pain may be less severe than with operations on other areas of the body. Opioids are used when necessary, but there are many other pain management options, including:
- Nerve blocks
- Lidocaine infusion
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What Is Minimally Invasive Heart Surgery
Minimally invasive heart surgery is an alternative to open-heart surgery. Instead of cutting through the breastbone to reach the heart, minimally invasive surgery involves small incisions that allow the surgeon to access the heart between the rib bones. These types of procedures are usually less painful and have a faster recovery than traditional open-heart surgery.
Each patient is unique. Our team will evaluate the specific health needs and recommend the most appropriate approach, taking into account the type of heart condition, the severity of the condition and the patients overall health status. Whenever possible, surgeons will use the least-invasive procedure.
Choosing The Best Approach
In choosing the best surgery option, its important for you to find a heart surgeon with experience in all approaches. The two of you then can work together as a team to decide how best to fix your problem.
Be sure your surgeon knows that you want to explore a minimally invasive option, says Dr. Burns. Dont be afraid to ask questions. Ask how frequently they do the surgery so you can get an idea of how comfortable and experienced the surgeon is.
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It Wasn’t Bronchitis It Was 90% Blockage In Her Left Anterior Descending Artery
Like many retired couples, Ann and Rich Guanella split their time between homes, spending half the year in Havertown, Pennsylvania, and the other six months in a small town in North Dakota. They had just journeyed to their lake home in the Upper Midwest when Ann felt pain in her chest while raking leaves.
“I have asthma and I just figured I was starting to get bronchitis because I was very congested,” she recalls. This was a few months into the pandemic and Ann, already worried about catching the coronavirus, decided she better get checked out. The next day, she and Rich drove to the local emergency department.
An examination and tests showed Ann’s lungs were finebut her heart was not.
The emergency department team believed Ann had at one time suffered a small and her symptoms were related to that. They urged her to follow up immediately with her primary care provider. Shortly after that, on June 26, 2020, Ann had a diagnostic to see how well her heart was working. Ann had blockages in each of her three main coronary arteries the most concerning was the 90 percent blockage in her left anterior descending artery . Because the LAD carries blood to large areas of the heart muscle, which pumps blood to the rest of the body, a significant blockage in this artery could cause a massive heart attack, known as the widow-maker. Ann’s cardiologist told her she would need coronary artery bypass surgery.
Benefits Of Minimally Invasive Heart Surgery
During minimally invasive heart surgery, our surgeons make tiny chest incisions to access your heart through openings between the ribs. This approach is less invasive than traditional open heart surgery, in which surgeons open the chest to access the heart.
- No opening of the chest or cutting of bones
- Faster recovery
- Minimal scarring
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What Are Some Types Of Heart Surgery
There are many types of heart surgery. The National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health, lists the following as among the most common coronary surgical procedures.
In addition to these surgeries, a minimally invasive alternative to open-heart surgery that is becoming more common is transcatheter structural heart surgery. This involves guiding a long, thin, flexible tube called a catheter to your heart through blood vessels that can be accessed from the groin, thigh, abdomen, chest, neck, or collarbone. A small incision is necessary. This type of surgery includes transcatheter aortic valve implantation to replace a faulty aortic valve with a valve made from animal tissue, MitraClipÂ® placement for mitral valve abnormalities, and WATCHMANÂ® placement for nonvalvular atrial fibrillation patients.
What Are The Possible Complications Of Tavi
Complications are possible because only higher-risk patients who cannot have open-heart surgery have this treatment. These include:
- Complications at the vascular access site such as pain, bleeding and bruising.
- Disruption of the normal electrical conduction system of the heart this may require treatment with a pacemaker.
- Aortic regurgitation due to the leaking of the aortic valve, which allows some blood to flow in the reverse direction.
- Stroke debris can break off the old valve and go to the brain.
- Death – if the complication is severe enough.
However, TAVI has been shown to be a life-saving treatment with dramatic improvements in quality of life. You can see a video of how it is performed here. The standard risk of all the above in total is about 5%. If you do not get urgent treatment, the risk without treatment is about 50%.If you would like to discuss treatment for your aortic stenosis, you can book an appointment to see Dr Malik at his clinic here. Cant make it in person? He is also available for a video call using our e-Consultation tool, which can be found on his profile too.
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