Catheter-based Mitral Valve Repair with the MITRACLIP
Transcatheter Aortic Valve Implantation (TAVI)
Catheter-based Renal Artery Denervation for Resistant Hypertension
The Watchman Device: A Novel Therapy for Prevention of Stroke in Atrial Fibrillation
Absorb Bioresorbable Vascular Scaffold
Dedicated Bifurcation drug-eluting Stent: Axxess Stent
Endovascular repair of aortic conditions: EVAR and TEVAR
Organ Transplantation and Mechanical Heart
Minimally Invasive Mitral Valve Repair and Replacement
Minimally Invasive Repair of Chest Wall Deformities
Cardiac Magnetic Resonance Imaging CMR
Real Time Live 3D TEE-guided Procedures and Surgeries
Sutureless Aortic Valve Replacement
PARACHUTE Left Ventricular Partitioning Device
Aortic stenosis is the most prevalent heart valve disease in the western world. This is a condition where the main outflow valve from the heart thickens due to degenerative changes that occur with aging and does not open fully. As all the blood leaving the heart has to go through the valve, severe narrowing of the valve causes restricted blood flow to the rest of the body, putting a strain on the heart and eventually causes breathlessness, chest pain, blackouts, and heart failure.
Once these symptoms occur, about 50% of patients will die within 2 years. (In comparison, 50% of cancer patients will die within 5 years).
Once the patients develop the above symptoms, the conventional treatment is with open-heart surgery and replacing the valve. However 30% of patients are deemed not suitable for surgery due to other concomitant medical conditions which make the surgery too high risk to be performed.
Transcatheter Aortic Valve Implantation TAVI, is a new technology which enables aortic valve replacement percutaneously without surgery, using a catheter via the femoral artery in the leg. This procedure has lower complication risk compared to surgery in high-risk patients and allows patients unsuitable for surgery to be treated. The recovery rate is also faster with less pain and trauma.
There are two different devices currently in the market. The Edwards device was first implanted in 2002 and the CoreValve in 2004. The device and delivery system have undergone a number of improvements over the years. The procedure can be performed under local anesthesia even with the patient being awake.
The procedure is conducted by a multidisciplinary team comprising of cardiologists, cardiothoracic surgeons, anesthetists and paramedical staff.
IJN started the TAVI programme on the 25th November 2009. We were the first centre in Asia to perform TAVI using the CoreValve device. Since then we have performed TAVI on 18 patients, the last being on 17th December 2011. There are 14 males (77.8%) with ages ranging from 68 to 84 years (average age 75.9 yrs). The procedural success rate was 100% and the median hospital stay was 7 days. All the patients are still alive and well with everyone having an improvement in their symptoms. The main complication was the need for a permanent pacemaker implantation in 3 patients (16.7%) and stroke in 1 patient (5.6%).
The valves were funded by IJN for the first 10 patients and the next 10 are from IJN Foundation. Recently the Ministry of Health has agreed to fund poor patients who are eligible under their Tabung Kebajikan Pesakit.