Uganda: Breakthrough Procedure to replace ‘Heart Valve’ at Aga Khan University Hospital


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You can now have a heart valve replacement procedure at Aga Khan University Hospital in Nairobi in case you have a narrowed main valve (Aortic Valve).

The procedure is performed using a novel technique that uses only two punctures in the groin.

This is a landmark procedure for the region, which removes the need for open heart surgery to enable the valve replacement.

DR JEILAN MOHAMED, a consultant interventional cardiologist at Aga Khan University Hospital and the lead expert in the procedure, shares insights about this procedure.

What expertise is required to conduct this procedure?

The technique of trans-catheter aortic valve implantation (known as TAVI) is only available in a few specialist centres around the world and requires a comprehensive team with experts who have internationally recognised experience in both open surgical and minimally invasive interventional techniques.

This team of specialists includes cardiologists, heart anesthetists, cardiac surgeons and specialist nurses.

Where in the region is this service available?

The Aga Khan University Hospital Heart and Cancer Centre is the only centre in sub-Saharan Africa outside South Africa which has met the international approval standards for this technology to be made available.

Doctors Jeilan Mohamed and Hasham Mohamed conducting a procedure at Aga Khan University Hospital Cathlab

Which problems do most patients needing the procedure present with?

In most of the patients who have so far been treated for heart valve replacement at the hospital, doctors have discovered a critical narrowing of the main heart valve (aortic valve), which is the main valve through which all blood is pumped from the heart. The patients complained of difficulty in breathing and easy fatigue.

This condition (aortic stenosis) is caused by rheumatic fever in younger patients or by progressive valve degeneration in older ones. It can only be treated by replacing the old valve.

The condition is progressive and, if left untreated, it may result in death within six months of the onset of symptoms in up to half of patients. Unfortunately, many patients present at an advanced stage, or when they are too ill or frail to have the open heart surgery.

How is the procedure performed?

The technique of trans-catheter aortic valve implantation allows the valve to be replaced using just two or three punctures in the groin and without the need for an open heart operation.

Using this technique, the heart specialists prepare the replacement valve which is then delivered through the groin backwards across the old narrowed valve. Using advanced x-ray techniques, the specialists remove the sheath and slowly expand the new valve into position.

Within minutes, it is able to function normally and takes over the function of the old valve. The whole procedure takes between one and two hours.
A team of cardiologists at Aga Khan University Hospital Cathlab

Are there any risks associated with the procedure?

The operation, like most heart operations, carries some risks. These include damage to the vessels in the leg.

A surgeon who is an expert in treating the leg arteries is usually needed to be on stand-by. In a small number of cases, a new heart pacemaker is needed because of the position of the heart’s natural pacemaker which is very near to the heart valve.

There is also a small risk of stroke, heart attack or even death. Because of the stringent requirements for approval to introduce this technology at any unit, it is only available in few centres around the world.

The availability of this treatment locally emphasises the significant strides that the Aga Khan University Hospital Heart and Cancer Centre has taken to enhance its reputation as a leading and world-class centre for heart patients.

What is the advantage of this procedure over open heart surgery?

The main advantage of this technique is that it is less invasive and is associated with faster recovery in most cases with patients able to get back to normal functioning much earlier. It is currently recommended for patients who, after review by a heart surgeon, are considered at high risk of an open operation.


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