LAHORE - Punjab Institute of Cardiology will introduce interventional procedure for treating cardiac ailment with replacement/repair of aortic valves of two patients without surgery in April this year, senior doctors told The Nation.
Prof Tanvir Bajwa, an interventional cardiologist from University of Wisconsin, USA, will carry out procedure of changing heart valves without any operation at the institute.
University of Wisconsin and the PIC have recently signed an agreement for introducing modern technique in treatment of heart patients in Pakistan.
Prof Tanvir Bajwa, who has so far replaced/repaired valves of more than 700 patients without surgery in the US, will train Pakistani medical experts by performing procedures in their presence.
Transcatheter Aortic Valve Implantation (TAVI) is the replacement of aortic valve of the heart through the blood vessels instead of conventional open heart surgery. Patients not well enough to have open heart surgery are offered TAVI procedure.
The procedure was developed in France, initially performed in 2002, is now approved in more than 50 countries. In the US, it received FDA approval in November 2011 for use in inoperable patients and in October 2012 for use in patients at high surgical risk.
A catheter (hollow tube) with a balloon at its tip is inserted into an artery in leg. The catheter is passed into heart and positioned within the opening of the aortic valve. Then the balloon is gently inflated to make room for the new tissue valve.
The new valve either expands by itself or is expanded using the balloon, depending on which type of valve is used. The balloon is deflated and catheter is removed. The new valve now sits inside damaged valve.
“Initially, Prof Tanvir Bajwa will perform procedure on two or three patients in April. The number of patients for TAVI procedure will increase gradually,” Prof Nadeem Hayat Malik, Chief Executive PIC, told The Nation yesterday.
“Dr Bajwa will train doctors by performing procedure in their presence. This will enable Pakistani doctors to use interventional technique for treating cardiac patients in near future. It will benefit elderly people and those at high surgery risk.
“Initially this technique was used on high risk and later on intermediate risk patients in the US. After FDA approval, it will be performed on low risk patients. It is quite common in developed countries these days and will gradually replace the conventional open heart surgery,” he added.
To a question that who and how patients will be selected for TAVI procedure at PIC, Prof Malik said that four-member heart team comprising a surgeon, cardiologist, anesthetist and image specialist will identify suitable patients after evaluating all reports. “We will send reports of these patients to the University of Wisconsin. From the given list, experts from the US will select two or three patients for TAVI procedure,” he added.
“Though the cost of such procedures is high, it will decrease with the passage of time. Presently it costs Rs3.5 million to Rs5 million. Still it is cost effective on selected patients. It takes months to patients to completely recover after open heart surgery.
“Use of antibiotics for infection control and prolonged stay at hospitals before and after open heart surgery are major issues. After TAVI procedure, patients can be shifted to homes immediately,” said Prof Nadeem Hayat Malik, adding cost was not an issue “as the government was ready to spend on health of the masses”.