Asia’s first valve implant without surgery

Star: KUALA LUMPUR: The National Heart Institute (IJN) achieved another milestone by performing the first heart valve implant in Asia without the need for open heart surgery.
The procedure has a 99% success rate.
Known as trans-catheter aortic valve implantation (Tavi), the procedure allows for problematic valves in the aorta to be replaced with an artificial one by using a catheter, a tube that is 6mm in diameter.
The tube is inserted either in the thigh or below the left collar bone and then slid through arteries to the heart.
“Patients, who have gone through Tavi, will be able to move around on the third day after the implantation but they will be required to lie down during the first 24 hours,” said IJN medical director Datuk Seri Dr Robaayah Zambahari during a press conference yesterday.
The procedure, which uses a device called CoreValve, causes less trauma to body tissues and enables a faster recovery compared to the conventional open heart surgery as only incisions are made at certain areas to insert the tube.
Dr Robaayah was part of the team of IJN consultants which performed the procedure on two patients on Nov 25; a 73-year-old man and a 77-year-old man, both of whom had severe narrowing of heart valves.
The third patient is National Laureate Datuk Shahnon Ahmad, 76, who was treated the next day.
Other team members were cardiologists Datuk Dr Rosli Mohd Ali, Dr Shaiful Azmi and cardiothoracic surgeons Datuk Dr Mohd Azhari Yakub, Dr Jeswant Dillon and anaesthesiologists Datuk Dr Mohamed Hassan Ariff and Dr Sharifah Suraya.
The procedure was assisted by Dr Ganesh Manoharan, a consultant interventional cardiologist from Ireland, who will oversee the operations of the next 12 to 15 patients currently on the waiting list.
The CoreValve device costs RM112,000 while another RM10,000 is needed for other operation costs.
Dr Robaayah hoped that the Health Ministry would support and subsidise the procedures for the public in future. The current ones were borne by the institute.
Dr Robaayah said there had yet to be any case of a patient rejecting the artificial valve, which is made out of a type of metal called Nitinol.
The procedure takes between 45 minutes and one-and-a-half hours.
“We took about two-and-a-half hours for the first patient because we were still learning about the procedure and wanted to be careful,” she said, adding that the method was only performed on high-risk patients such as the elderly.
Dr Ganesh said local anaesthesia was applied to the patients and they remained conscious during the procedure.
“It is not surprising to see patients smiling as we conduct the procedure on them,” he said.
Dr Ganesh said about 50 centres worldwide were using the technology, adding that it was suitable for Asians as their blood vessels were generally smaller.