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Last week, a new page of high-tech low-traumatic care was opened in our Research Center: interventional cardiologists of the institution successfully performed the first surgeries that gave many patients a chance to survive. Moreover, they were performed by the “puncture method”: without incisions and general anesthesia. Transcatheter implantation of the aortic valve and endovascular repair of abdominal aorta allow to reach new stage in development of care for patients suffering from cardiovascular diseases.
Organization of one more center capable of taking some of those surgeries was certainly important event in the life of entire region, because nowadays in our country there is a pronounced shortage of surgeries for transcatheter implantation of aortic valve.
Aortic valve stenosis (or narrowing of the opening of the aortic valve) at onset of the disease practically does not limit the life of the patient and may be asymptomatic. However, as soon as characteristic symptoms appear (shortness of breath with minimal exertion, syncope, swelling in the legs), predicted life expectancy of such patients is reduced to 3 years and the risk of sudden cardiac death increases by 50%. This happens because the blood ceases to fully flow into the aorta, to organs and systems, the heart stops to cope with its work.
Until recently, the only treatment for aortic valve stenosis was open heart surgery - aortic valve replacement. During such surgery, an incision was made in the middle of the chest, a heart-lung machine was connected, the heart stopped, and a non-functioning valve was replaced with a prosthesis.
Despite the effectiveness of this procedure, risks and complications remained high in elderly patients, so they were often denied surgery and prescribed only supportive drug therapy. For almost 20 years, such patients have been undergoing transcatheter aortic valve implantation: TAVI, which gives a chance to restore valve function and bring back normal physical performance without anesthesia, incisions and long-term rehabilitation.
Galina Lvovna from Tyumen was 89 years old! She was one of five patients who had a prosthetic aortic valve implanted through a puncture.
The patient shared how she had felt so bad, just suddenly, and she had fallen. Physicians recommended her surgery because valve in her heart had not been working. But anticipation was too long: 1.5 years! Suddenly she was called, informed about the opportunity to have a surgery in our center. It was happiness! She needed to look after her son, because he is disabled. She agreed. Galina Lvovna was surprised by such teamwork of all staff. She thanked very much for the rescue. Deepest gratitude! She understood that she would not survive open surgery with incisions.
Stanislav Sapozhnikov,MD, PhD, interventional cardiologists said that five aortic valve implantations and two abdominal aortic replacements were performed over a period of 2 days. Our center contrived to perform these surgeries, where there was no great cardiac surgical support, and only low-traumatic methods of treatment were used. However impressive theoretical background, many years of practice in different areas, support from more experienced colleagues during surgeries were accessible. Therefore, despite the fact that all patients were very difficult, age-related, with a large number of concomitant diseases, our experts were only going to positive result. And got it!
One more patient who successfully underwent TAVI surgery was Yuri Alekseevich from Saratov region.
He visited his children in our city, and became ill; he remembered that had been so weak: “like a rag”. The children brought him to our center, where he was examined and treated. The patient was explained the valve did not work and operable only by one third, so he was weak. The situation was hopeless and surgery was needed, but it was necessary to wait for a while. He didn’t want to have his chest operated. Another decision was via femoral artery. Patient was waiting, thinking that would be prescribed drugs. But challenge appeared. He didn't even believe to be invited to our center. The decision was made. He was nervous; he wasn’t Superman as the patient said. He saw surgeon was also tense, but without panic, without haste, everyone worked together in surgery theatre so he completely trusted our experts. Many thanks were got by the whole team. And when he found himself out in a ward, nannies, who delivered food, came and congratulated him! He said that those women were warm-hearted people!
Endovascular repair of abdominal aortic aneurysm is also of great interest. Abdominal aortic aneurysm is detected by routine screening. About 75% of patients with abdominal aortic aneurysm are smokers, men over 65 years old with arterial hypertension. In one of our patients, abdominal aortic aneurysm grew almost to the size of a soccer ball. Ruptured aneurysm quickly becomes life-threatening, although before that it might not be painful at all. The standard treatment for an aneurysm is open surgery. Our Center now offers patients such a progressive minimally invasive procedure of endovascular (intravascular) prosthetics of abdominal aorta, which is more and more respectable all over the world. This is procedure in which a stent graft is implanted through small incisions in the groin into the blocked artery without extensive surgical access, creating a new channel for blood flow. Subsequently, blood flows through the newly formed artery and the aneurysm thromboses over time, and, accordingly, the possibility of its rupture is neutralized.
It should be mentioned that all surgeries were performed within the framework of federal funding.
Our specialists plan to increase the amount of these surgeries, introduce new technologies in TAVI surgeries, including the use of the most up-to-date types of aortic valves, new implantation techniques for safer surgeries, and participate in scientific research.
