An 83-year-old woman became the first patient in Kenya to undergo aortic valve replacement without being put under general anaesthesia.
The two-hour procedure was done at the Aga Khan University Hospital when the patient was fully awake, having only received local anaesthesia (paracetamol) with mild sedation. Valvular heart disease affects many Africans and is commonly related to rheumatic heart disease. A large number of patients require heart surgery to treat the problem. In most cases, heart valve surgery involves opening the chest, stopping the heart, and connecting the patient to a heart-lung bypass machine while the surgeon replaces the valve.
The trans-catheter aortic valve implantation (TAVI) procedure has recently been introduced to enable patients who cannot undergo open heart surgery have this procedure performed using two punctures in the groin.
A CONSCIOUS PATIENT POSES A GREATER THREAT
“The patient is given paracetamol and we numb the skin at the hip where a cut of two to three inches will be done. We then use a guiding wire that navigates through the artery and aorta into the heart. Once the tip arrives at the aortic valve, it acts as a guide to the catheter,” said Dr Mohamed Jeilan, the director of the cardiac programme at Aga Khan University Hospital.
A valve is squeezed into a small narrow tube which is delivered over a small wire introduced through the groin to the heart. The heart valve is made of memory metal, which springs back to its original shape once the tube is removed. The margin for error involved requires advanced technology and expertise. The fact that the patient is awake poses an extra challenge since the patient may move and dislodge the valve.
The advantages of this procedure include no cutting of bones, almost negligible blood loss and reduced risk of infections because the incision is small and the patient does not require intensive care monitoring which means that the patient can be discharged earlier than usual.
The first patient to undergo this procedure was discharged three days after the operation.