Patients suffering from aortic valve disease but unable to withstand open-heart surgery are benefitting from an innovative procedure that uses a €22,250 catheter to snake through an artery from the groin.

Patients can leave hospital after a couple of days as opposed to a week for open-heart surgery

Twenty patients have already undergone the successful intervention, known as trans aortic valve implantation (Tavi), since it started being performed at Mater Dei Hospital’s Cardiology Department two years ago – even before some other countries have introduced it.

The procedure cuts down on operating and recovery time, reduces trauma and does not require general anaesthetic. It was used mainly on the elderly, in their late 70s, and whose health complications meant undergoing open-heart surgery would be too risky, explained cardiologist Albert Fenech.

Younger patients, who could not have their chest opened up again because they would have already had bypass surgery, were also good candidates for the 90-minute operation that only required sedation, he said.

Before the technique was introduced, such patients had no other option, Prof. Fenech said. Elderly patients suffering from sick valves – a common ailment – would have two years to live if they could not undergo open-heart surgery and the quality of what was left of their life would be poor.

The department had applied to carry out the procedure four years ago but was not granted a licence because it had to guarantee 20 patients a year.

“But we persisted and eventually got it,” he said, adding that the department was now even training others overseas.

Demonstrating by means of a recorded intervention, Prof. Fenech outlined how the artificial valve was crimped onto a balloon on a tube, resembling a “fishing rod”, and inserted through the femoral artery.

As it travels up the body, the catheter can be bent to accommodate the arch of the aorta. Once it reaches the damaged valve, whose function is to allow blood to circulate in one direction, the balloon is inflated and the artificial counterpart is stretched open, pushed against and anchored onto the aorta wall. Each Tavi costs about €24,000 as opposed to €12,000 for open-heart surgery, of which the department carries out 250 a year. Of these, 30 to 40 are aorta valve replacements.

Once its long-term outcome was analysed, it could be the way forward for such ailments, Prof. Fenech said. Patients could leave hospital after a couple of days as opposed to a week following the ordeal of open-heart surgery.

Health Minister Joe Cassar said the major advances at the department were not only good news for the Maltese but also on an international level in that it was a “reference point”, including teaching others. The fact that the government and hospital management introduced innovative procedures for patients, which they previously either had to travel for or did not even exist abroad, was a sign it had policies and vision.