Waikato pair advance cardiology

23:20, May 27 2013

Waikato Hospital specialists have pioneered a new technique to treat one of the most prevalent heart-valve diseases in the Western World.

Aortic regurgitation is a condition where the heart's main outflow valve fails to close properly. This causes the blood that has already pumped out of the heart to leak back into the organ.

Waikato cardiologist Sanjeevan Pasupati and cardiothoracic surgeon Adam El Gamel have developed a technique to successfully treat patients with the condition.

Over time, as the heart stretched to accommodate the extra blood, it became strained, leaving patients breathless and at risk of heart failure, Mr El Gamel said.

"Traditionally, replacement of the aortic valve has required open heart surgery," he said. "However, 10-15 per cent of patients who need surgery for aortic regurgitation have other conditions that make it dangerous for them to undergo open heart surgery."

Now surgeons are applying the Edwards Helio system technique involving a cardiologist working from the leg and a cardiac surgeon working simultaneously through a small chest incision.


Dr Pasupati said the pair worked together to insert an anchoring device from the leg, to place it outside the patient's aortic valve. A new valve was passed through the chest and the tip of the heart and placed inside the docking device.

"The whole apparatus is held in place by the old aortic valve, which is sandwiched between the docking device and the new valve," he said. "This procedure corrects the leak and acts as an alternative to major heart surgery."

Dr Pasupati and Mr El Gamel, who are both involved in teaching the use of transcatheter implantation techniques around the world, worked with Edwards Lifesciences to develop the Edwards Helio system programme.

Four patients have been successfully treated using this approach in New Zealand.

Although the procedure has had a successful trial period, it remained "experimental" and would undergo several years of refinement before it would be ready for mainstream use, the two colleagues said.

The treatment is an extension of another technique pioneered for New Zealand at Waikato Hospital in 2008 called transcatheter aortic valve implantation. This is used to treat a narrowed aortic valve (aortic stenosis), and involves a new valve being passed up from the leg, arm, or through a minimal incision on the chest.

Until now there was no similar procedure available for aortic regurgitation because anchoring the new valve was a challenge.

Waikato District Health Board internal medicine leader Clyde Wade said the groundbreaking technology was "the culmination of a 30-year journey".

"We've gone from a cardiological backwater in Hamilton to now being internationally recognised," Dr Wade said.

Waikato Times