Antwerp surgeons find key to better heart surgery

Summary

Cardiologists from Antwerp’s Middelheim Hospital are the first in Europe to replace deep-lying valves in the heart using keyhole surgery

A change of heart

Of all the heart valves, the mitral is the hardest to reach. When this valve, which ensures that no blood flows back from the left ventricle to the left atrium, needs to be replaced, the surgeon needs hours to open the entire thorax to reach and replace the defective valve.

During the operation, the heart has to be stopped, which is always tricky. It goes without saying that this operation is not appropriate for older, weakened patients.

To replace the artery valves – which connect the right and left ventricles with, respectively, the lung artery and the aorta – doctors use keyhole surgery to minimise the impact on the patient’s condition and to shorten the length of the operation. But for the atrioventricular valves, which separate the atria from the ventricles, keyhole surgery is not really an option because it’s so difficult to reach the valves without damaging the heart tissue.

But it’s not impossible, as doctors from Antwerp’s Middelheim Hospital have shown. In November, the mitral valve of an 85-year-old woman was replaced using keyhole surgery (pictured). While her heart kept beating at a normal pace, theAntwerpdoctors made a three-centimetre incision in her left breast into which they inserted their medical instruments. After having pricked the heart, they positioned and attached the new valve.

“The entire intervention took just 20 minutes,” says Dr Stefan Verheye, the cardiologist who replaced the valve. “And after spending only one day in intensive care, the woman recovered rapidly from the intervention. Immediately after the operation, she admitted that her shortness of breath had largely disappeared.” Shortness of breath is one of the consequences of a poorly functioning mitral valve.

European first

This was the first time in Europe that a mitral valve had been replaced by keyhole surgery. The intervention was part of an international examination to test the new technique, which was developed by a Canadian medical firm.

The technique was first applied in Vancouver on patients who complied with the regulation of compassionate use – experimental therapies may be used if there’s no other remedy. “These patients were much too weak for open-heart surgery, and without a quick replacement of their mitral valve, they would soon have died,” says Verheye.

Verheye was part of the team that made this first intervention inVancouver. He hopes that patients in his hospital in Antwerp will soon be able to receive the same treatment.

Photo (c) Het Nieuwsblad

These patients were much too weak for open-heart surgery

- Dr Stefan Verheye

Just like a car engine relies on valves to control the inflow of fuel and air and the outflow of combustion gases, our heart needs valves to prevent blood from flowing in the wrong direction. And just like a car engine wears out as the mileage counter reaches a certain point, our heart valves begin to show signs of wear as we grow older.

“There are two kinds of valvular heart disease,” explains Verheye. “In the degenerative form, the valve shows signs of wear due to physical causes such as ageing or previous infection. In the functional form, cardiovascular disease can cause an imperfect closure of the valve. In both cases, the defective valve needs to be replaced.”

Verheye is an interventional cardiologist and not a cardiac surgeon in the narrow sense of the word. He only performs interventions. “While a cardiac surgeon uses his eyes to study the heart, once he has laid it open, and to replace the valve, we use technical instruments to study the patient’s condition. For example, before an intervention we make a full 3D scan of the heart. We use that scan to build a full-scale model of the heart with our 3D printer. By doing this, we can check whether the artificial valve will fit perfectly.

“The valves themselves are not made to the size of the patient. But, thanks to the revolution in 3D printing, this will also be possible in the future.”