Belfast Telegraph

Thursday 23 October 2014

Royal Victoria Hospital team leads way in amazing new heart valve surgery

Dr Ganesh Manoharan with his team (from left) Bernie Smith; Fiona Kelly; Richard Gould; Grainne McCaffrey; Huhan Bennett; Ruth KirkPatrick; Mark Spence; Sandra Gowdy; Gay Medenilla; Sean O'Conaire, Lilia Cilladolid and Chris Lockhart in the Royal Victoria Hospital in Belfast

A team at the Royal Victoria Hospital is leading global efforts to develop new life-saving technology.

Cardiologists and patients from Northern Ireland have taken part in the first human-based trial in the world of a heart valve replacement device.

And now a consultant cardiologist at the RVH is leading the next major trial for the device, known as the St Jude Medical Portico Transcatheter Aortic Valve Replacement (TAVR) system, which could result in it being used to save lives around the world.

Dr Ganesh Manoharan said: “This is an amazing device and I am very excited that we have been given the opportunity to lead the way on this.”

TAVR is a keyhole procedure used to repair the aortic valve — one of the four heart valves that control the flow of blood in and out of the heart.

Without treatment, patients will eventually die.

In younger patients without any other health complications the standard treatment is open heart surgery.

However, this is more dangerous in older patients as the recovery time is longer and many of them suffer from other health problems.

As a result, TAVR was established about a decade ago to allows doctors to repair damage without major surgery.

Efforts are under way to try and enhance the procedure with the creation of the portico transcetheter heart valve, which is even easier for doctors to position in the body.

Dr Manoharan explained: “We have used two different types of valves for this but in both there were problems if we weren’t happy about the location of the valve.

“With one of them, if we weren’t happy about the position of the valve we had to start all over again with a new valve, which means the procedure becomes more complex.

“However, with the portico transcatheter valve, we can move it around until we are entirely happy with its position.

“We were the first centre in the world to carry out the first human-based trial with this device, because of our expertise in carrying out this procedure.

“During the trial the device was fitted in 10 patients and the results were very encouraging, with all patients doing very well.

“The valve is proving to truly be a next-generation technology. It really is phenomenal and has produced some very exciting results.”

The device could be implanted in up to 100 people a year in Northern Ireland if it becomes standard treatment.

Dr Manoharan said this could result in massive savings for the health service.

“If you want to be really cynical about this, you could say this will allow elderly patients to return to their normal lives and live independently.

“Because the procedure is not invasive, patients do not require intensive care afterwards so those beds are freed up and can be used by other seriously ill people.

“We are also usually able to discharge patients after about five days after the procedure and, because they are going home, this reduces the pressure on social services.

“The patients are happy and healthy and less likely to return to hospital. There are multiple benefits.”

As a result of his involvement in the trial, Dr Manoharan has travelled around the world training other doctors to use the device.

“I am able to use that expertise and knowledge to benefit patients in Northern Ireland,” he said.

“This development has only been possible because of funding from a variety of sources, including the Ulster Garden Villages, Heart Trust Fund and the Cardiac Research Fund.”

‘I was walking the next day without getting out of breath’

It looks like a piece of chicken wire wrapped around a bit of white plastic — but in reality it is a medical device that could save countless lives around the world.

The St Jude Medical Portico Transcatheter Aortic Valve Replacement (TAVR) system looks set to revolutionise the treatment of patients with a life-threatening heart condition.

Aortic stenosis is the abnormal narrowing of the aortic valve — one of the four heart valves that control the flow of blood in and out of the heart.

This results in a restriction in the flow of blood in the heart that can ultimately lead to sudden death.

Consultant cardiologist at the Royal Victoria Hospital Dr Ganesh Manoharan said: “We use TAVR in elderly patients who are clinically suitable because it is less risky than open heart surgery. The patient is awake throughout the procedure, it is done without a general anaesthetic.

“The procedure is carried out while the heart is still beating. We make a small incision in the groin into the femoral artery into which we pass a catheter containing the valve.

“This is fed up through the artery until it reaches the heart. We monitor the position of the valve by X-ray. Once in position, the new valve starts to work instantly and the patient will

feel the benefit right away.”

And Dr Manoharan added: “The difference with this valve compared to others currently being used is that we can move it about if we are not happy with the position.

“It can be completely resheathed into the catheter which allows us to reposition the valve at the implant site.”

Dr Manoharan implanted the Portico device in Samuel Cull (83), from Portadown on Monday.

Mr Cull said: “I wasn’t nervous about having the procedure done. They explained what was going to happen and I asked them to do it the next day.

“I was awake throughout and the nurses were talking to me telling me what was going on.

“Before I had the valve fitted I couldn’t even walk 50 yards but I was up the next day walking around the ward without getting out of breath. I am looking forward to getting back home for Christmas. Without this valve I wouldn’t have been able to do that. I wouldn’t have survived.”

Dr Manoharan said: “When I first met Mr Cull he wasn’t too bad but as time went on his condition deteriorated significantly to the point where he couldn’t walk without getting out of breath.

“It is amazing to see the benefits to the patients.

“Even though I have been involved in so many of these procedures I am still amazed when I see how well they respond to the treatment.”

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