Outside the Box: Kazakhstani doctors have invented new methods of applying innovative technology to treat severe heart diseases

08.12.2022

In the summer of 2022, the doctors of the Heart Center faced an unusual situation: a 34-year-old patient was admitted to the clinic with a severe pathology requiring two surgeries at once. In addition to necessary implantation of an "artificial heart" called an LVAD, the patient also needed replacement of the previously installed mechanical valve with a biological valve, in order to reduce the risk of thrombosis or valve dysfunction in the future. Similar surgeries have been previously successfully performed at the Heart Center, however, in this situation, the patient was in an extremely serious condition, and there was a very high risk that he would not survive the long two-stage operation requiring temporary cardiac arrest.

The doctors had a task: to minimize the duration of cardiac arrest during surgery.

An out of the box idea for solving this problem came from an adjacent field of cardiac surgery - interventional cardiology (minimally invasive cardiology). It was decided to use the TAVI technology but in a completely different way, which has never been used anywhere before...

About TAVI.

Since 2012, the innovative technology of transcatheter aortic valve implantation (TAVI) has been introduced at the Heart Center. This is a minimally invasive procedure to replace a damaged valve. Unlike open heart surgery, where a heart-lung machine is used, transcatheter implantation of the aortic valve is performed on a beating heart and in most cases by access through the femoral artery without opening the chest. This significantly shortens the rehabilitation period.

This method is used in two events: in case of valve calcification (when calcium is deposited on the base of the valve and restricts the free opening and closing of the valve leaflets; here calcification acts as a framework for fixing the transcatheter valve), or in case of dysfunction of a previously implanted biological valve (a new one is installed in the frame of an existing valve - the so-called “valve to valve” technique).

Initially, this method of valve replacement was used in elderly patients who are contraindicated in open-heart surgery due to the high risk of complications, both during and after surgery. However, in recent years, the TAVI technology has successfully established itself as a more secure alternative to the “open method”, thus expanding the list of indications for using this method.

This technology is used transcatheterally, that is, via a vascular access. However, the doctors at the Heart Center came up with the idea to apply this method during an open heart surgery to reduce the valve suturing time using the traditional way.

As mentioned above, the patient had a previously prosthetic mechanical valve, so after obtaining open access to the heart, the doctors removed the leaflets of the mechanical valve, while leaving the prosthesis frame. A new biological transcatheter valve was also implanted into it.

The procedure takes no more than 3-4 minutes, while the traditional method of the surgical re-prosthetics of the valve can take up to several hours.

Immediately after that, doctors installed an LVAD "pump" on the patient's heart, and the operation ended successfully.

A similar story had a 60-year–old patient of our clinic - a non-functioning valve with reduced contractile function of the heart. However, his situation was further complicated by the fact that, unlike previous patients, he had neither a previously implanted valve nor calcification – there was nowhere to fix the valve using TAVI technology.

Then, the doctors decided to preliminarily install a support ring (which is used for the surgical treatment of valve insufficiency) in place of the valve, using only 3 sutures, and after that TAVI was implanted in it. This technique minimized the duration of the operation, thereby significantly reducing the existing risks. The patient has now fully recovered and is doing well. The new development formed the basis for an innovative project to study methods of treating patients with chronic heart failure.

In total, the doctors of the Heart Center applied this innovative hybrid method of TAVI installation to 11 patients.

Moreover, doctors in collaboration with the engineers are now thinking about how to complement the TAVI technology in order to expand the indications for its use. Thus, significantly expanding the number of patients with valvular pathology to whom the minimally invasive method can be applied.