New heart procedures for frail and aging patients

 
In October 2013 Professor Olaf Wendler, Clinical Director of Cardiology and Cardiothoracic Surgery at King's College Hospital London performed a new surgical heart procedure for the first time in the UK called less invasive ventricular enhancement or LIVE.  
 
New procedures better for an aging population
The path breaking operation uses a new device, developed by Bioventrix, Inc. that enables surgeons to effectively "exclude|" scarring. The procedure involves re-modelling the patient's left ventricle, which is the part of the heart responsible for pumping oxygen rich blood to the body, whist the heart is still beating.  It's particularly suitable for elderly frail patients suffering from chronic heart disease and the benefits include small incisions, faster recovery and better outcomes.  
 
With traditional open-heart surgery the surgeon makes a ten to twelve-inch incision and then gains access to the heart by splitting the breast bone and spreading open the rib-cage. The patient is then placed on a heart-lung machine and the heart is stopped for a period. This approach, inappropriate for frail older patients with advanced heart disease, can be associated with postoperative infection, pain and a prolonged recovery time.
 
In the next 25 years, the number of people over 65 is estimated to increase by 65%, with a doubling of the number of people over 85. A high proportion of this large and growing elderly group will suffer from coronary heart disease and be too frail for traditional open heart surgery, which carries a high risk of complications and often does not result in acceptable outcomes.
London Centre of Excellence for minimally invasive heart procedures
King's is recognized as a centre of excellence for the treatment of heart disease and has developed a strong and successful interaction between cardiologists, cardiac surgeons and ambulance services.
 
The new procedure performed by Wendler is a result of cooperation between cardiac specialists including Professors Theresa McDonagh, Clinical Lead for Heart Failure and Mark Monaghan, Director of Non-Invasive Cardiac Diagnostics.
 
Such cooperation helped King's to become the first hospital in the UK to carry out primary angioplasty for myocardial infarction (PAMI) and its specialist cardiac unit to become the first in the UK to be open 24 hours a day. 
 
Primary angioplasty pioneered at King's
Patients suffering heart attacks in London are brought directly to King's for primary angioplasty therapy. The procedure involves unblocking clots in the artery, which can cause a heart attack and is achieved by inserting a stent (a small metal tube) via an artery up to the heart. The stent is put in place using a tiny balloon and, when complete, opens the blocked coronary artery.
 
Primary angioplasty is now the gold standard in cardiac units throughout the UK.
 
Previously emergency treatment for heart attacks was a thrombolytic (clot-busting) drug, which was only about 60 to 70% successful and many patients went on to suffer further clots. By contrast, angioplasty achieves a normal blood flow in some 90 to 95% of cases.
London Valve Live '09
Surgical innovations such as those performed by Wendler and his colleagues are predicated on years of R&D. In 2008, King's was awarded Â'£9 million to establish a British Heart Foundation Centre of Research Excellence. 
 
An important focus of this group at King's is translational or bench-to-bed research. So called, because it enables research discoveries to be translated into new therapies and their outcomes fed back into further research and education.
 
In 2009 a group of world renowned experts in cardiology and heart surgery met in London to discuss how advances in aortic and mitral valve surgery and minimally invasive techniques pioneered at King's were making a real difference to patients with heart valve disease.
 
Delegates watched, via a teleconference, patients undergoing two path breaking procedures, which demonstrated how minimally invasive techniques were changing the way patients with chronic heart conditions were treated.  
 
On show then was a transapical aortic valve implantation, which involves an artificial heart valve being implanted by a cardiac surgeon directly through the left side of the chest while the heart is beating and without having to go on a bypass machine. Also delegates watched an apercutaneous or transfemoral aortic valve implantation, which involves an artificial heart valve being implanted into the heart by a cardiologist through a leg artery, again with the heart beating.
 
Takeaway
"The cardiac units at King"s and Guy's and St Thomas are working to bring clinical excellence and cutting-edge research closer together and make it available for patients in the UK", says Professor Wendler. 

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