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Mater Dei: New Treatment for cardiac condition when open heart surgery is not an option

 - Thursday, 29 March 2012, 00:00

by Keith Micallef

Patients with particular needs who up to some time ago could not be treated for defective heart valves, which in medical terms is referred to as severe aortic stenosis, now have the option of being treated thanks to a new technology introduced recently at Mater Dei called Trans Aortic Valve Implantation (TAVI).

Although patients suffering from this condition normally undergo open heart surgery, in certain circumstances this is deemed as too risky for the patient. Often they are left with no other option, and in some cases they succumb to the condition within two years of being diagnosed.

The majority of cases involve elderly people, who due to other complications cannot withstand such a major operation. Younger people might still be at risk, in those cases where the patient had previously undergone a bypass operation which severely restrains future interventions in the chest area.

Members of the media were yesterday morning briefed of these latest developments by Cardiologist, Professor Albert Fenech at Mater Dei Hospital where he gave a brief demonstration of this procedure which takes about 90 minutes to carry out. He said that thanks to this new technology which was only licensed worldwide about four years ago, in the last two years 20 Maltese patients were treated, the oldest being 89 years old and the youngest 30. Prior to that a particular patient had to be sent abroad.

Prof. Fenech said that during this brief period Malta’s success rate did not go unnoticed abroad and Malta is already being considered as a benchmark for those countries who are still introducing this new method. In fact, Malta will be assisting the Romanian authorities where TAVI is in the process of being licensed.

This new procedure does away with open heart surgery and instead a valve is introduced via the femoral artery by means of a catheter through a small incision with the patient sedated. Once in the correct position the valve is positioned and deployed across the patient’s aortic valve using a special inflatable balloon, which is then removed leaving the valve firmly in place. As a precaution patients are temporarily fitted with a pacemaker during this procedure.

“In a sense it is a like fishing rod, with the valve attached at the end mounted on an inflatable balloon” explained Prof. Fenech in simple terms.

Contrary to standard open heart surgery, patients undergoing TAVI need a much shorter recovery time usually in the range of three days, and not a whole week. However this new technology comes at a cost of €24,000 which is double the cost of standard open heart surgery.

Though the procedure was officially licensed in 2007, negotiations with local authorities started immediately and the only stumbling block was the fact that Malta could not guarantee a minimum of 20 patients a year. Once this was no longer an issue TAVI was added to the ever increasing list of new technologies being offered at Mater Dei.

Meanwhile Health Minister Joe Cassar, paid tribute to the high level of expertise in the cardiology department in Malta, with both Professors Albert Fenech and Alex Manchè being pioneers in this field. He said that recently Philips nominated Malta as a showcase for the Cathlab in the Mediterranean region, and this is further proof of the high levels of medical care in Malta.

“Malta has become a reference point in health services, as demonstrated by the Breast Screening Unit which is being considered as a successful model by the World Health Organisation (WHO). Meanwhile Government is striving to introduce more technologically advanced treatments, to be of greater service to the local patients and reduce as much as possible the need for going abroad”, boasted Dr Cassar.

On the same lines, Prof. Fenech said that the major factor behind his decision to come back to Malta 17 years ago, was the suffering of the patients and their relatives, he was personally witnessing.

Prior to the introduction of angioplasty, about 500 open heart surgeries a year was the norm. This now has decreased to about 250, of which 40 are cases that are each year diagnosed with severe aortic stenosis. Prof. Fenech explained that in future TAVI may even replace the need for open heart surgery.

Though the main culprits for cardiac complications are familiar, such as lack of exercise and diets richly based on fats, statistically, the situation in Malta is still very alarming with the highest per capita cases of diabetes in the world. This, together with the obesity factor, are contributing to an exponential surge in cardiac complications.

“This is why Government last month launched the National Strategy against Obesity, and is dedicating €25 million to the cause, as prevention is the best way to deal with it” pointed out Dr Cassar.

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