Arab Health 2020: Heart surgery 'through groin' offers hope to patients in UAE

Cardiologists expect wider use of the less-invasive technique - known as MitraClip therapy - in the near future.

Dr Robert Smith, a consultant cardiologist explains how an aortic valve can be fixed without needing open-heart surgery. Antonie Robertson / The National

Older patients with heart problems now have a greater chance of survival without the need for open heart surgery.

Doctors from the Royal Brompton and Harefield Hospitals, the UK’s specialist heart and lung centre, were at the Arab Health exhibition in Dubai to demonstrate how surgeons can now replace faulty heart valves using just a small incision in the neck or groin as an entry point.

“There is a burgeoning market for this kind of keyhole surgery in older patients,” said Dr Robert Smith, a consultant cardiologist at the hospitals.

“You can address each part of the heart valve to fix it with just a small incision.

“This technique has been around for five years, but now the data has caught up with the practice and we know how successful it is.

“High-risk elderly patients with comorbidities, who we may not have operated on before, can now consider surgery as the risks are lower.

“Tablets are not always going to do the job. If a valve is broken, the patient will die within a few years.

“We see 90 now as the new 80, the changes we have seen to geriatric surgery are astonishing,” he said.

The mitral valve and tricuspid valve control blood flow between the heart’s chambers. If the mitral does not close completely, blood can flow backwards at high pressure.

Known as mitral regurgitation, this backwards flow forces the heart to work harder to push blood around the body. Symptoms of MR include fatigue, shortness of breath and worsening heart failure. It can also put further pressure on the pulmonary vessels, and in severe cases, can cause fluid to collect in the lungs. MR can be related to age, coronary artery disease, underlying heart muscle disease or a birth defect.

The MitraClip device is a small clip that is attached to the mitral valve. It treats MR by allowing the mitral valve to close completely and helps restore normal blood flow through the heart.

To install the device, a small incision is made in the groin and a catheter is inserted in the femoral vein. The MitraClip is then guided to the heart and positioned to grasp both sides of the valve, regulating blood flow between the chambers.

The procedure usually takes between two and three hours immediately reduces mitral regurgitation, with a much faster recovery time.

The Middle East has some of the highest rates of cardiovascular disease. Until recently, heart surgery has often been the only option.

That option is risky and expensive, particularly in older patients.

Evolving techniques using keyhole surgery to repair clogged or damaged valves are proving an effective method to increase survival rates in elderly patients.

The over 65s in the region make up 4.7 per cent of the population, but over the next 30 years this is expected to increase rapidly with a fivefold increase in the UAE alone.

An ageing population is expected to become a burden on healthcare spending as older people are more prone to chronic illness like cardiovascular disease.

Minimally invasive cardiac procedures increase the chances of survival in older patients who may have been considered high risk for open heart surgery.

Such techniques are not widely used in the UAE but that could change as more surgeons become trained in specialist techniques.

“Patients can now have heart surgery and go home on day two,” said Dr Smith.

“In previous open heart surgery there would be significant time in hospital for those over 80, with a one in five chance of death.

“It is very invasive but also very expensive with amount of rehabilitation that is required.

“This is the future of surgery. We can now replace heart valves with very small incisions but soon we will be able to pass whole valves up through the groin.”