Major cardiac milestone reached

Pictured: A/Prof Antony Walton and A/Prof Ron Dick

For over a decade, Epworth has cared for high-risk cardiac patients needing replacement of an aortic valve by using a minimally invasive procedure, called TAVI or Transcatheter Aortic Valve Implantation.

We recently reached a major milestone - 1,000 TAVI procedures carried out at Epworth Richmond.

That’s 1,000 patients who have been able to avoid open heart surgery, by having their damaged valve repaired through the insertion of a catheter through a small cut in the groin.

Interventional cardiologists began using this technique at Epworth Richmond in 2010 and now up to 13 TAVI procedures are performed each week.

Associate Professor Tony Walton, Clinical Lead for the Structural Heart Program at Epworth, was instrumental in setting up the program and supervises interventional cardiologists to become accredited TAVI practitioners.

“Epworth was the first private hospital in Australia to perform TAVI and continues to lead the private sector,” A/Prof Walton said.

“In addition, Epworth is the leading private hospital in Australia to perform TAVI and has an active research program to improve patient outcomes.”

Epworth is part of the ACE consortium, along with The Alfred and Cabrini.

“This provides a perfect platform for collaboration and makes us leaders across all of Australia and New Zealand,” A/Prof Walton added.

Diana Lee, Structural Heart Coordinator, says the program was initially limited to high-risk patients with severe aortic stenosis, who were thought to be not well enough to survive open heart surgery.

“This included patients who were elderly with multiple medical conditions. The safety of TAVI compared to open heart surgery is very well established and now intermediate and low-risk patients are eligible,” Diana explained.

“There are standardised tests and measurements we use to assess the eligibility of each patient including ultrasound of the heart (echocardiography), radiology (CT scan of aorta and groin arteries) and coronary angiograms. We have to ensure it is safe for us to access the heart from the groin and that the heart arteries do not require fixing as well.

“The TAVI valve is also an option for patients who have had open heart surgery before and now have failing surgical (tissue) valves, so they do not require another open heart procedure.

“Generally, patients and their families would prefer TAVI to open heart surgery if they are eligible. With TAVI, the patient recovers quicker and can go home quicker, avoiding a stay in the ICU and a longer rehabilitation compared to open heart surgery.”

Kate Steen, Director of Clinical Services Epworth Richmond, says TAVI numbers have had significant growth in the last four years. In 2010, Epworth undertook 15 of these procedures, with 25 in 2011.

“We now perform more than 150 TAVI procedures each year,” Kate said.

“I would like to acknowledge the support and efforts of specialist doctors, the nursing staff in the 2 Lee Coronary Care Unit (CCU) who look after TAVI patients, our Structural Heart Coordinator, cath lab staff and our cardiac educators who provide support and guidance to CCU nurses.

“Without the teamwork of our doctors, nurses and educators, we would not be able to provide such outstanding, high-quality care for our complex cardiac patients.”

A/Prof Antony Walton and Dr Samer Noaman

Read: "One of thousand" - Bob Spong - who recently had a TAVI procedure at Epworth.