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Unique alternative to open heart surgery

Unique Pulmonary Valve Procedure FAQs

Typically what type of medical conditions will benefit from this new technique?

The technique benefits children born with heart defects, particularly children born without a connection between the pulmonary artery and the right ventricle of the heart (congenital condition). Traditionally, multiple surgeries are required to fix the problem throughout their lives due to their rapid growth. The average child benefiting from this technique will have had open-heart surgery three times before.

Traditionally, how does open-heart surgery work?

A conduit (finger-sized plastic tube containing a valve) is implanted to connect the heart’s right ventricle to the blood vessels of the lung. Unfortunately, the valve contained in them progressively becomes inefficient. This causes a big volume of blood to seep back into the right ventricle through the leaking valve. Ultimately, this leads to the right ventricle becoming over worked, and the patients can become significantly tired. Therefore, a conduit is not a solution for life and children affected by this unfortunately have to face numerous operations in order to avoid over working the heart. Repeat surgery is often required around every seven years to 10 years.

How exactly does the valve procedure work?

The valve is mounted inside a stent – an ultra-thin, collapsible platinum mesh cylinder of the type commonly used to prop open weak or narrowed arteries. The stent and valve are collapsed, then mounted on a tiny deflated balloon at the end of a catheter. The stent on the catheter can then be introduced into a blood vessel. Once the catheter reaches the correct place the balloon is inflated and the stent expands to the required width. The balloon is then deflated, the catheter is withdrawn and the stent remains in place. The valve survives this compression and inflation in fully working form, which is why the procedure is so effective. As this non-invasive technique bypasses the need to open the chest, the child can leave hospital within 24 hours, and avoids the need to be on Intensive Care.

Why is the valve procedure a preferred option to open-heart surgery?

Traditionally, open-heart surgery has been required to correct the problem by inserting replacement valves, but this carries difficulties for patients as it normally involves opening up the chest, cutting through the sternum (breast bone) and several weeks of recovery. Replacement valves also degrade and the original problem returns. Therefore, with open-heart surgery the valves are replaced less frequently than is clinically ideal, which can compromise the patient’s quality of life.

Who was the first case to benefit from the technique?

Professor Bonhoeffer applied the new technique in France (Hopital Necker, Paris) on a 12-year-old boy for the first time in 2000, whose heart was showing signs of enlargement because of a ‘backwash’ of blood from his pulmonary artery. With the patient under general anaesthetic, the catheter carrying the valve and stent was introduced via a vein in his upper leg. The valve began to function immediately and the boy’s heart returned to normal. He is still well although this particular patient did require surgery some years later.

What are the other key benefits of Professor Bonhoeffer’s procedure?

His procedure is much less invasive and less traumatic to patients than open-heart surgery and recovery is also a lot quicker. Each re-opening of the chest for surgery is progressively more difficult so it is of major benefit if this can be avoided.

The procedure also allows more timely and frequent repair of the conduit. The heart muscle of the right ventricle is prevented from further damage. More frequent repair means the proportion of time the children spend with an inefficiently working heart is reduced. In turn, the children will be less tired, and have an increased life expectancy.

Do replacement valves need to be replaced?

Like those fitted during open-heart surgery, replacement valves inserted via catheter will not last forever. But the hope is that, if necessary, these patients – and others like them – can receive three or four replacement valves using this method before further invasive surgery is required. This will make valve replacement dramatically less traumatic.

How long does the procedure take and what is the success rate?

On average, it takes one hour to perform and there have been no deaths linked to Professor Bonhoeffer’s procedure.

Does the procedure only benefit children?

About half those treated have been children and half adults. Professor Bonhoeffer also performs this procedure on adults at the well-known Heart Hospital.

What hope does this procedure offer for the future?

Non-surgical techniques for the treatment of heart ailments are steadily growing. Professor Bonhoeffer believes that his close collaboration with the cardiac surgical team is a clue to this successful program. The valve procedure has the potential to address previously unmet needs of tens of thousands of children worldwide. Professor Bonhoeffer’s team are working with the catheter manufacturer NuMed and the valve’s maker Medtronic, a global medical technology company, in facilitating this process of education and moving towards rolling out the technique worldwide.

How many patients are benefiting from this procedure?

Once the program is rolled out worldwide we expect that 3000 – 5000 patients will benefit from the procedure each year (between 200 – 300 cases in the UK each year).

How much does the procedure cost?

The procedure will be less costly than the otherwise necessary surgery. This is mainly due to the costs of intensive care and complications which can occur with surgery.

Who funds valve replacements at Great Ormond Street Hospital?

UK patients are seen on the NHS.

This page was last updated on 29 August, 2008

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