Dressed in pyjamas and sharing a joke in the Canberra Hospital’s recovery ward, octogenarians Ian Gaun and Dorisse Tucker are sprightly and animated but in disbelief, that each was on an operating table, undergoing heart surgery, just 24 hours earlier.
- The Canberra Hospital has begun offering a minimally invasive heart procedure called transcatheter aortic valve implantation, or TAVI
- As part of the procedure, an artificial valve is placed inside a catheter, which is guided through a blood vessel in the groin to the heart
- It is hoped the alternative to open-heart surgery means fewer Canberrans with aortic stenosis have to travel interstate for treatment
“I feel alive again! It’s absolutely wonderful!” Mr Gaun said.
“I feel as though I haven’t even had an operation, you know? It’s just amazing,” Mrs Tucker agreed.
Their new lease on life is thanks to a minimally-invasive procedure being offered, for the first time, at the Canberra Hospital: transcatheter aortic valve implantation, or TAVI.
The operation is a high-tech repair of the heart’s “exit door”, or aortic valve, which allows blood to flow from the left ventricle to the rest of the body.
“As time goes on, with age and other factors, this becomes stenosised; narrowed, or tight,” Dr Nikhil Pal, the UK-trained staff specialist recruited to offer the procedure at Canberra Hospital said.
“Because of which enough blood cannot come out of the heart. And, if it can’t reach your vital body organs, say, your lungs, you can’t breathe. If it can’t reach your brain, you feel faint.”
Research suggests aortic stenosis affects close to 100,000 people, with an estimated 10,000 new cases a year, and without treatment, 50 per cent of sufferers will die within five years.
Mr Gaun, 86, was a former Lieutenant commander in the the British Royal Navy and remembers enjoying cross-country running and fishing.
“I noticed my breath becoming shorter and shorter,” he said.
Mrs Tucker was similarly symptomatic at 82.
“I love to do yoga and all of those sort of things, and I was just getting so breathless,” she said.
“I had open-heart surgery scheduled and the doctor, who was doing to do it, spoke to me about Dr Pal’s procedure.”
The hour-long TAVI operation is minimally invasive, using small incisions — or keyhole cuts — and an artificial valve, made of animal by-products, attached to a deflated surgical balloon.
The valve is placed inside a catheter, or flexible tube, and guided through a blood vessel in the groin to the heart, where the balloon is inflated and, rather than replacing the damaged valve, the new one sits securely within it using a stent made of circular metal mesh.
Lake Macquarie Private Hospital, in the Hunter Valley, has been offering TAVI since 2014, while Tasmanians have had access since January 2020.
Until now, Canberrans have had to travel for treatment
Dr Pal said Canberra patients had previously been forced to travel to Sydney or Newcastle for the procedure, which he said involved “a lot of travelling, finding accommodation, and then recovering from the procedure there”.
He explained that for regular open-heart surgery, there was a long recovery time.
“For a fit healthy person, it can take anywhere up to three months. But at their age, it can be longer — almost double, six months or more,” he said.
Some risks are still associated with TAVI, according to St Vincent’s Hospital, including bleeding, and abnormal heart rhythms.
But Dr Pal said many of his patients were up and about the next day or home in a few days.
“I was already doing TAVI surgeries [elsewhere in Australia] for more than four years, but this region needed it and I came for the patients,” he said.
“We’ve gone through the entire process — of initial consultations to the procedure, to recovery and then follow up — in one place, with the same team.”
That continuity of care, as well as not having to have more invasive surgery, were aspects Mrs Tucker described as a “joy”
Something Mr Gaun agreed with, describing feeling “amazing” just a few days after the procedure.
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ACT Health Minister Rachel Stephen-Smith said the ability to provide this treatment locally was an important step for public health patients in the ACT and surrounding region.
“The ACT government is continually expanding health services to ensure Canberrans can access high-quality public health care where and when they need it,” she said.
“Introducing specialised treatments such as TAVI at Canberra Hospital is another example of the government’s commitment to providing quality treatment as close to home as possible.”
National Capital Private Hospital also started offering TAVI two months ago.
At Canberra Hospital, Dr Pal already has a waiting list and expects to perform up to 120 TAVI procedures a year, once the new critical services building opens in 2024 as part of the Canberra Hospital expansion project.
Fellow senior cardiologist Dr Charles Itty is also training to lead the two-surgeon procedure.
“This is a great achievement from the team after a challenging few years in the department and an indication of what high-end services we can provide for the region,” Dr Peter Scott, who previously worked with the TAVI program at Melbourne’s Austin Hospital, said.
Canberra Health Services is currently advertising for another cardiology specialist at Canberra Hospital and a structural heart and TAVI coordinator for North Canberra Hospital.
“We are now on par with any leading tertiary institute in Australia,” Dr Pal said.
“It’s a lot more attractive for new doctors, specialists, who will see us as a beacon of attraction; they will want to come here.”