The high-tech heart valve that lets you breathe easily again
21:47 GMT, 18 June 2012
Surgery to replace a faulty heart valve can sometimes fail.
Edna Watkins, 89, a retired occupational therapy instructor from Spalding, Lincolnshire, had a new type of valve to avoid the problem.
'Sometimes I felt very faint and once or twice I blacked out,' said Edna Watkins
Even though I’m in my 80s, I’m very active — I go dancing with friends a few times a week (I’m a widow) and love going on days out, too.
But about four years ago, I noticed I was getting increasingly tired and breathless.
My GP sent me for tests, including an electrocardiogram (ECG), to check my heart’s electrical activity.
The specialists told me there was a problem with my aortic valve, the main valve in the heart. It had become stiff with calcium, which can happen with age, so wasn’t working so well.
This meant my heart was having to work extra hard, and not enough blood — and oxygen — was reaching my organs, which was why I was feeling so breathless.
They said they could replace the faulty valve, but they’d have to cut through my breast bone and the recovery would take up to three months.
I was told it would be incredibly gruelling at my age, so instead they’d just keep an eye on me with regular check ups.
But the breathlessness just got worse — three years ago, I had to give up dancing entirely.
Just climbing stairs left me gasping, and heavier jobs like mowing the lawn were too much.
Sometimes I felt very faint, too, and once or twice I actually blacked out, which was frightening.
My consultants sent me to Dr Jan Kovac. He said he could replace the valve by keyhole, so there was no big incision — just a small one on my thigh. He’d guide the valve up to my heart using X-rays.
'In the next few days as I recovered, I already felt better and less breathless,' said Edna
However, he said the only problem with doing it this way was that sometimes the replacement valve wasn’t put quite in the right spot, where the old faulty one was.
If this happened, it meant blood still wasn’t pumped out of the heart properly, and the breathlessness would come back.
Dr Kovac said he was doing a trial of a new valve that could be moved about in the heart until it was definitely in the right spot, so the success rate was much higher — I’d be the first patient in England to have it.
I had the operation in February and it took less than an hour.
I was woozy when I woke from the general anaesthetic, but there were no huge bandages and no pain, just a small dressing each side of my groin.
In the next few days as I recovered, I already felt better and less breathless.
I stayed in hospital for six days, and then spent a week in a rest home.
Now the breathlessness has eased so much that I can enjoy days out with friends again.
I can walk and climb steps so much more easily — though I don’t think I’ll be going dancing just yet.
Dr Jan Kovac is a cardiologist at University Hospitals of Leicester. He says:
Narrowing of the aortic valve is very common — it affects about 400,000 Britons and we are seeing it more and more, as it’s most common in elderly patients, and the population is ageing.
The aortic valve is the major valve in the heart. It has three triangular flaps which open and close to meet in the middle, pumping blood out of the heart to the rest of the body.
While doctors do not fully understand why this valve can become narrowed as we get older, we know calcium is deposited in these flaps, so they stiffen and cannot open and close as efficiently.
The heart has to work harder to pump blood round the body and ultimately can fail to do so.
Narrowing of the aortic valve is very common – it affects about 400,000 Britons and we are seeing it more and more
This results in patients starting to feel breathless — they may also have chest pain and syncope (fainting).
In extreme cases they could die suddenly, since the heart can no longer pump oxygenated blood to the body.
Over time the heart itself becomes damaged and more than 50 per cent of patients don’t survive two years if not treated.
The traditional gold standard treatment, which has been around for more than 50 years, is open-heart surgery to replace the valve with one made from animal tissue or metal.
This is major surgery which means a stay of up to ten days in hospital and up to three months recovery. And since this is a disease of older people, around 30 per cent of patients are not fit enough for it.
So in the past five years we’ve started using keyhole surgery, making a small incision in the thigh or the arm and then sliding the replacement valve up in a catheter, or thin tube, to the heart.
The valve is anchored within the calcium of the patient’s diseased valve and stays in position unaided.
However, one of the issues of using keyhole techniques means we’re more at risk of not placing the valve exactly in the right position.
It’s crucial that it is positioned precisely inside the damaged natural valve, otherwise it will leak and blood will not be pumped through efficiently.
If this happens, the patient might have the same breathlessness and faintness after some time.
We are trialling a new valve, the Portico 23, made from animal tissue, which can be moved and repositioned in the heart, so we can place it precisely.
Unlike the traditional valve, which we shoot out of a catheter and only have one chance to get it in the right spot, this one is inside a stretchy covering made of elastic metal mesh.
The mesh is very pliable and we can use control buttons linked to the catheter to angle it accurately in the heart, and even take it back into the catheter to try again.
We’ve only been trialling the valve since February this year, so we do not have long-term data yet, but we hope this will give us a new way to reduce the risk of the valve leaking.
The procedure takes under an hour, with the patient either sedated or under general anaesthetic.
First, we make a puncture a few millimetres long in each thigh to access the arteries. I slide a catheter through an artery up to the damaged valve — the catheter contains a deflated balloon.
Another catheter goes through another artery to inject dye into the aorta so we can see the area on X-rays and ultrasound.
We inflate the balloon in the damaged, stiffened valve to stretch and widen it a bit.
Next, we take it out and, using another catheter, we deposit the new replacement valve inside the old valve, checking its position using X-rays and ultrasounds.
Using control buttons on a machine connected to the catheter I can move and reposition the valve as many times I need until we have the best position.
Then I slide the catheters out and seal the punctures using a small closing stitch.
The patient usually spends three to seven days in hospital, but goes home without a chest wound or long recovery period.
There is some risk of complications, including bruising to the groin, or even that the patient might need a pacemaker because these are often elderly people.
This is incredibly exciting because it could help many more patients who are not well enough for surgery, and end the breathlessness and fainting so they stay well and active.
he current valves cost the NHS about 15,000. If the trial is successful, it is hoped the procedure will be more widely available by the end of this year.