Innovative heart interventions which until a few months ago were only available to patients who attended hospitals abroad are now being carried out at Mater Dei’s Cardiology Department.
One such innovation is the bioresorbable vascular scaffold, a small mesh tube that opens blocked heart vessels, restores blood flow to the heart and then dissolves within two years without leaving any trace of metal in the body.
Speaking to The Sunday Times of Malta ahead of the annual Maltese Cardiac Society conference held at the weekend, Cardiology Department chairman Robert Xuereb said the first of these interventions was successfully carried out in June.
Six patients have since benefited from this treatment, and none has suffered any complications. The scaffolds, as they are more commonly known, are made of polylactide, a natural material that is commonly used in dissolving sutures. They are an improvement on the metal stents which work in the same way but do not dissolve.
“Arteries are made of muscle and these should be able to close, open up and remodel. Stents may not always allow this movement which could over time cause further complications,” Dr Xuereb said.
Patients with heart problems would often require multiple stents to correct the problem, he said. “Ultimately, some patients would end up with a full metal jacket inside their artery which increased the risk of thrombosis.
Within a few years, there is no trace of them in the body
“While scaffolds do pose a higher risk in this respect, in the long-term they are deemed safer as within a few years, there is no trace of them in the body.” Patients are not affected by the dissolving process since the scaffolds are made from natural material.
While acknowledging that scaffolds are the way forward, Dr Xuereb said they had not yet completely replaced stents. “We have to keep in mind that scaffolds are still in their infancy, they are what we call first generation, and so we cannot use them in every lesion.”
At the moment, only patients with stable anginas may receive the treatment since data from clinical trials are still being collected.
Patients under 60 are more likely to be eligible, Dr Xuereb added.
The cost of these new temporary structures is also a determining factor. While stents would normally cost €260, the price of a scaffold could go up to over €1,000.
As a result, Dr Xuereb said the department was being very cautious when choosing patients for the new intervention. “Our national health scheme cannot afford giving everybody scaffolds. That is one reason. But we have to also keep in mind potential risks and so we have come up with a set of guidelines to help us choose those that would benefit most.”
Dr Xuereb said he is pleased with how quick the hospital had been implementing such a procedure.
“We were not the very first in Europe to introduce scaffolds because we wanted to ensure there was sufficient information and that we were well-trained before carrying out the procedures. At the same time, we did not want to be the last.”
Dr Xuereb said that the department was now at a stage where cardiologists were not only specialising in a specific area, but also sub-specialising to offer better all-around service.