Scalpel-free heart surgery

The patient, a mother of two, was in critical state as a result of heart failure. Due to acute infection it was impossible to carry out surgery on the open heart. The infection destroyed the valve which had been transplanted more than a decade before. Additionally, so many calcifications and fibroses appeared that there was not enough healthy tissue which another valve could be sewn onto. It was impossible to perform a traditional operation.

Through the femoral artery to a valve

The only chance to save the patient was a minimally invasive procedure which consists in implanting an aortic valve in the ring of the one which had been destroyed by the infection. It was performed in the Invasive Cardiology Department of the Upper-Silesian Medical Centre in Katowice-Ochojec.

The procedure was carried out using a catheter through the femoral artery. First, the valve was destroyed, crushing it with a balloon dilated under 4 atmospheres of pressure (twice as much as used in car tyre). Thanks to this the old valve could be replaced by a new one prepared beforehand.

In this case, a TAVI aortic valve was used. Initially it is coiled – only in this form can it be squeezed through the artery. After inserting it in the right place it is dilated to the right size.

The only chance of treatment

The TAVI procedure was first conducted 10 years ago; in Poland it has been performed since 2009. It is used on patients with many complications, usually in old age, in whom an open-heart operation is too risky. The patient subject to the procedure in Katowice-Ochojec was an exception in respect of age.

“In 2013 the TAVI aortic-valve transplant procedure was performed in Poland on 380 patients. In the majority of cases good results of treatment were achieved, which is documented in a medical and economic assessment by the National POLTAVI Register", says Professor Zembala, a national consultant in the field of cardiosurgery.

It has been estimated that each year there are around 3 thousand people who do not qualify for a valve transplant. For many of them a minimally-invasive procedure is their only chance. It usually involves transplanting a valve by the use of a catheter through the femoral or subclavian artery (alternatively from the apex of the heart).

The “Valve" to be repaired

Apart from transplanting the TAVI aortic valve, other minimally invasive replacement or repair procedures of other heart valves are performed. This way, e.g. mitral valve dysfunctioning is eliminated.

It is located between the left auricle and the left ventricle and has the role of a “valve". When it does not close properly, a certain amount of blood goes back to the lungs, lingers there and causes dyspnea. In time this leads to heart failure.

Without opening the chest, using 3D cardiac echo, the doctors precisely diagnose the areas which do not close and then – through a puncture in the right groin – insert an implant to the heart with a catheter, which helps the valve function well again.

As Professor Adam Witkowski, the manager of the Cardiology and Intervention Angiology Clinic in Anin, states, minimally invasive procedures are more often performed without general anaesthesia only in deep sedation and local anaesthetic. The patient can get out of bed as early as the next day.