“I wouldn’t have known I’d had a heart operation at all. It’s quite incredible!”

Dr Mark Turner MB ChB(Hons), MRCP, PhD

Cardiology Department, Level 4, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW Mark.Turner(at)ubht.nhs.uk

Major Ratcliffe, a 92 year old retired Officer, was a referred to me by ExtraLife (a specialist private cardiology company). He had aortic stenosis (a narrowing of the main outlet valve of the heart) a potentially life threatening problem that can cause breathlessness, dizziness or chest pain. Open-heart surgery is usually needed to replace the valve, however at 92 the risks of this would have been high.

Medical technology moves at a rapid pace. In 2002 I worked with Professor Bonhoeffer in London when he implanted the first heart valve without surgery in the UK – a pulmonary valve between the heart and the lungs. We began implanting these Medtronic valves at the Bristol Royal Infirmary in 2007 after they became generally available. Recently, the CoreValve* company have developed a novel transcatheter aortic valve for elderly patients with aortic valve stenosis that we started implanting at the Bristol Royal Infirmary in January 2008 after it was cleared by the European and UK regulatory authorities.

Major Ratcliffe’s breathing was deteriorating so we decided to perform the new ReValving(*) procedure. To check he was suitable we performed a detailed ultrasound scan (echocardiogram) and an angiogram where I passed tubes (catheters) into his heart through the blood vessels. This showed that he was suitable for the new valve and the procedure was funded by the Exeter Friendly Society under the terms and conditions of his insurance policy.

Under a general anaesthetic a tube was placed in the artery at the top of the leg. A balloon was passed up through the narrowed valve to stretch it open to make way for the new valve. The new bioprosthetic valve is mounted on a memory metal (Nitinol – a Nickel Titanium alloy) frame that can be compressed into a 6mm diameter tube (even though the valve is between 29mm and 4cm across when expanded). Using X-rays and ultrasound the new valve is released from the catheter in the correct position and its frame expands itself to its full size and the valve immediately begins to work. The 6mm hole in the artery was sealed with a stitch device. Major Ratcliffe was woken up straight after the procedure and went to the coronary care unit. The day after he was able to stand and move around his bed space and after a few days he went to the general ward. He needed very few pain killers and was much less breathless than before. With the help of the physios he was mobile around the ward in a few days and went home after a week. He does not need warfarin (a blood thinner frequently used after valve surgery if a metallic valve is used) but takes Aspirin and a super Aspirin called Clopidogrel. He continues to do well with breathlessness not being a problem any more. After open surgery you would expect a stay of 3-4 days on the intensive care unit and about 2 weeks in hospital, followed by several months of recuperation.

When I telephoned him to see how he was and to ask if I could share his experience with you he said; “I wouldn’t have known I’d had a heart operation at all. It’s quite incredible!”

Percutaneous (through the arteries) aortic valve replacement is not suitable for all patients. Surgery is still the best treatment for most patients. However if the risks of open surgery are high, due to old age or other medical problems, the CoreValve transcatheter valve procedure offers a real alternative. The recovery is quicker and pain much less. Before any patient can be offered this new procedure a thorough examination must be performed by a specially trained cardiologist. More information on the assessment of aortic valve patients can be obtained from ExtraLife.

Biography: Mark Turner was formerly a Royal Navy Doctor specialising in Diving and Submarine Escape and is now a Consultant Cardiologist based in Bristol, specialising in Structural and Congenital Heart Disease interventions, such as closing holes in the heart and valve procedures. He is one of a handful of cardiologists in the World who implant both Aortic and Pulmonary valves without surgery.

*CoreValve® and ReValving® are registered trademarks of CoreValve, Inc, USA