The first open-heart surgery was performed in 1953 and now more than a million open-heart surgeries are performed every year. Although safe it is but natural for any surgical technique to evolve. 


Minimally Invasive valve surgery or key-hole valve surgery as it is commonly referred to is a good example. Key-hole techniques require special training and dedication so that the results are comparable to the traditional open operations. Being minimally invasive has direct patient benefit, which is not just cosmetic but functional. There are many options today for a surgeon and a patient to choose from including novel Transcatheter heart valves. 

 

Being a world expert in this field, Vinnie will be able to discuss with you all available options and their risks and benefits so as to choose the best option for you. 

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Traditional Heart Valve Surgery

More than 5000 aortic valve operations are performed in the UK every year. Majority of these operations are performed by splitting the breast bone completely (red line).


A heart-lung machine is then used to stop the heart while the abnormal valve is removed and replaced with an artificial heart valve made of either metal or animal tissue. 


The valve is sutured under vision and hence has the least chance of malfunction.


This is considered as the Gold-standard treatment for aortic valve operation/replacement. This is the preferred option if the patient is fit and suitable for open heart surgery i.e low risk and medium risk.


It is important to understand that this approach provides the best access to the heart and hence is comparitively easy to perform.


Advances in surgical techniques, equipment used for Heart-lung machine and excellent post-operative care have dramatically reduced complications associated with any open heart operation.


Despite the perceived invasiveness, it has very low complication and mortality rates in UK and all over the world.




Preferred for combined procedures like bypass & valve  

in Low Risk and Medium Risk patients



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Key-hole Heart Valve Surgery

Less than 10% of aortic valve operations are performed through Key-hole surgery or approach.


Key-hole aortic valve replacement is performed either by splitting the breast bone partially (red line) or by completely avoiding this by accessing the aortic valve through the rib cage (blue line). The latter technique is currently performed in a select few hospitals in Europe and USA. 


Vinnie has now started performing this procedure and is the only surgeon performing this in UK. This is suitable for at least 80% of the patients depending on the internal anatomy. Benefits are - less or no use of blood transfusion, less trauma and hence early recovery.


In this operation, the patient is connected to the heart-lung machine like in a traditional operation and the abnormal valve is removed and replaced. The operation is however performed through a key-hole. This is the preferred option if the patient is fit and suitable for open heart surgery i.e low risk and medium risk.


Thus it is the gold standard treatment which is less invasive.








Preferred for isolated valve operation

in Low Risk and Medium Risk patients


 


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TAVI

Transcatheter Valves

Transcatheter Heart Valves were introduced in UK in 2008. St. Thomas' Hospital has one of the largest and most prestigious TAVI programmes in Europe.

 

TAVI is performed thorugh a small cut in the leg or over the ribs and a new valve is placed within the abnormal heart valve under X-ray guidance. In 2009, Vinnie introduced an alternative way of performing TAVI, the Trans-aortic route (TAo). This is less traumatic to the patients and is now being performed all over the world.

 

Vinnie has by far one of the largest experiences in training centers in TAVI all over the world and has helped set up TAVI programs in Europe, Asia, Australia, South America and South Africa.


TAVi is also referred to as a Key-hole operation and although performed without connecting patient to the Heart-lung machine, it leaves behind the abnormal valve. Experience in TAVI is comparitively new and hence at present it should be reserved for patients who are high risk for open heart surgery. 


Vinnie has recently performed the first-in-world Mitral valve implantation of the FORTIS valve on compassionate grounds.






Preferred for isolated 

aortic valve in 

High Risk patients

 

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Valve-in-Valve

Historically the only option for patients presenting with a failing artificial heart valve was a repeat operation. With developments in the field of TAVI, patients can now be treated with  a  TAVI valve. This is less invasive and is referred to as Valve-in-valve.  


Artificial heart valves vary in shapes, sizes and their basic design. Understanding which valve is suitable for TAVI is of paramount importance to acheive the best result. 


Vinnie has led the research work in this area and has designed two smartphone Apps which serve as a reference tool for the valve manufacturers and TAVI users all over the world. These Apps are educational and free and can be downloaded from the App store and Google marketplace. 


At present he is working on a project to provide imaging guidance to TAVI users who intend to treat patients with failing tissue valves in the Mitral position. This is a rapidly evolving area and has its own challenges.


Research work in this area is being carried out at St. Thomas' Hospital in collaboration with all heart valve manufacturers and the Departmnent of Biomedical Engineering at Kings' College London and has already led to several frontline publications.





Preferred in High Risk patients

with failing tissue 

Heart valve