Minimally invasive procedure means less pain, reduced risk of infection and a shorter recovery time, writes Dr MUIRIS HOUSTON
A CARLOW WOMAN has successfully undergone the first keyhole heart valve surgery in Ireland in an operation performed at the Blackrock Clinic in Dublin.
A team led by consultant cardiothoracic surgeon Michael Tolan, replaced two heart valves for Harriet Gould in a procedure that avoided the usual incision through the breast bone.
Instead, a small incision was made in the right side of the chest wall and the heart visualised by means of a telescopic camera. The surgeon performed the minimally invasive endoscopic heart valve surgery with specifically designed long-shafted instruments.
The benefits of the new procedure, which requires a 5cm incision rather the traditional 25cm route through the breastbone, include reduced post-operative pain, less blood loss and a reduced risk of infection. In addition there is less residual scarring, and the patient can expect a faster recovery and a shorter stay in hospital.
It is performed using cardiac bypass, which, because of the small incision, is especially challenging for the anaesthetist and the other team members.
Ms Gould (67) had her tricuspid and mitral valves replaced by Mr Tolan and his team, and was discharged home at the weekend. Previously she had had her aortic valve replaced, followed by surgery to the area of the heart surrounding the valve.
In her particular case, it meant the chance of dying from a traditional heart surgery procedure would have been very high at about 15 per cent. The endoscopic procedure offered an alternative with a much reduced risk of mortality of about 2-3 per cent.
“For valve surgery, this will be a very attractive approach,” said Mr Tolan. “While it is still not a minor operation, the recovery time is much shorter and the impact on the patient overall is much less. The procedure is complicated but is part of the trend of making surgery less invasive for patients.”
Heart valves regulate the flow of blood through the heart’s four chambers: two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles).
The heart valves can malfunction either by leaking or by not opening adequately and thus partially blocking the flow of blood.
Mr Tolan, consultant anaesthetist Dr Fionnuala Lyons and a team of nurses and cardiac perfusionists – who focus on supporting the normal functions of the heart and lungs during the surgery – from the Blackrock Clinic travelled to Belgium to train in the new technique over the past three years.
They have been working with Dr Hugo Vanerman, the head of the OLV Hospital’s Cardiovascular and Thoracic Surgery Unit at Aalst, Belgium. Dr Vanerman developed the procedure and is regarded as the world leader in the field.
The new approach is currently available only at the Blackrock Clinic, but it is expected it will be performed in cardiothoracic units in public hospitals in the State eventually.