Centre of excellence: Royal Brompton and Harefield hospitals innovative heart surgery

 اذا كنت مقيما في دبي، اضغط هنا لقراءة المقال باللغة العربية (If you are based in Dubai click here to read the article in Arabic)

اذا كنت مقيما في مصر، اضغط هنا لقراءة المقال باللغة العربية  (If you are based in Egypt click here to read the article in Arabic)

Royal Brompton and Harefield hospitals revolutionary technique simplifies up to four heart surgeries into one

Digital, Innovation and technology - three of the globally trending key words of the decade in healthcare. There are a few names with ground-breaking innovations worthy of mention and Mr Toufan Bahrami, a consultant cardiac surgeon at Royal Brompton & Harefield Hospital Specialist Care (RB&HH Specialist Care), is one those pioneers. Mr Bahrami together with the team based at Harefield Hospital developed an innovative technique to minimise the time heart patients with complex cases spend undergoing surgery and recover faster.

Revolutionary technique avoids numerous surgeries for heart patients

Rising number of cardiovascular diseases (CVD) in the region has reached worrying levels for families, individuals and also governments. As heart problems develop the risk of complications increases, and the likelihood that these problems will affect multiple elements of the heart’s functioning also rises. Translating into increasingly complex cases of heart disease that require specialist care to solve them.

Mr Bahrami developed and pioneered a revolutionary heart procedure that is suited to heart patients needing multiple surgical procedures. Patients suffering from multiple life-threatening heart problems can have up to four surgical procedures completed during a single operation, using minimal access techniques.

Speaking with Mr Bahrami about his revolutionary technique, he explains “We have developed a procedure that traditionally would be up to four different heart surgeries - fixing the mitral valve, tricuspid valve, ablation, and left atrial appendage closure. Now this all can be done in one surgery with quicker recovery time."

The procedure is very beneficial for the thousands of patients each year who develop multiple heart problems – for example serious cases of high blood pressure, stroke, or irregular heart rhythms - as it saves them from undergoing several separate operations. This also helps reduce the disruption to their daily life, allowing them to get back to their families, hobbies and work much more quickly, rather than undergoing another heart operation within a short space of time.

He highlighted “Depending on the condition of the patient, the surgery is either conducted ‘off-pump’ while the heart is still beating, or a heart-bypass machine is used to stop the heart for as little as 10 minutes compared to 30 minutes in traditional surgery.”

A centre of excellence

In this procedure, Mr Bahrami instead of accessing the heart via sternotomy (a large incision through the breastbone), he accesses the heart via a handful of small cuts.

The instruments used in video-assisted surgical procedures are also different to those used in traditional surgery and it takes many years of training to develop the skills needed. The procedure is both very delicate and sophisticated with "the operation being video-assisted, utilising a state-of-the-art 3D camera and a large high-definition monitor, which gives an extremely clear view inside the body, instead of using direct vision, which requires a larger access port. The aortic valve (the valve in the heart that holds the oxygen-rich blood which is pumped out to the body) is accessed endoscopically with three small access holes. One for the camera, one to put a clamp on the aorta, and one to expose the valve.”

Mr Bahrami adds “Every week, we do at least two of these types of surgery. The number of times we have performed this procedure has made us outstanding. I do not recall anyone else doing mitral, tricuspid and ablation in the same set. Usually they treat the mitral valve and then leave the other parts without treating them. "

Only a handful of other hospitals in the UK and offer mitral valve surgery using keyhole techniques and very few who can treat multiple problems in one operation – all endoscopically like at Harefield Hospital.

 “We have done mini-access heart surgery here since 2001. The programme that we are doing today has at least fifteen years’ experience behind it"

Quicker and better recovery

The operation takes about three hours and the patient typically stays at the hospital to recover for around five to seven days.

Comparing the mini-access procedure to the more standard sternotomy approach, Mr Bahrami clarifies “The length of stay in the hospital is mainly the same; what makes a difference is afterwards. The integrity of the chest is preserved, so therefore the recovery is much quicker. Those who have a sternotomy can suffer for around two to three months. They often cannot go back to work nor drive for eight weeks at least. They can be very slow in recovery.”

He explains that particularly for obese patients, with traditional surgery they could spend “months” in the hospital. But with minimally invasive surgery they can go home after a much shorter period as their recovery is so much better – in as little as three days. Patients’ symptoms and quality of life is improved by fixing up to four issues in one go: the mitral valve, tricuspid valve, ablation, and left atrial appendage closure.

It takes a team

This revolutionary technique is available to patients thanks to the years of innovation and expertise from researchers and clinicians at Royal Harefield hospital, including Mr Bahrami.

“The whole operating theatre team – anaesthetists, nursing staff, and perfusionists – have been trained and are experts in the technique.  It’s not just one person who knows how to do the procedure or how it works – there is a whole team who are ready to do it. They have the skills and are used to it. Everyone is comfortable, and we always have a plan for the operation. We have done many surgeries of this type.”

Best Practise exchange

Royal Brompton and Harefield hospitals have a long history of ground-breaking medical innovations that have increased treatment options and improved the lives of patients with complex heart and lung conditions from all over the world. In response to growing health concerns surrounding heart and lung disease, Royal Brompton & Harefield Hospitals Specialist Care has established strong relationships in the UAE with the Dubai Health Authority and The Ministry of Health. They are meeting with healthcare organisations in Egypt as well to help deliver better clinical outcomes for patients. Further details will be released in coming months.