Life-saving procedure - the first of its kind
When the patient first reported to Cardiologist Dr James Blake with aortic stenosis, no one was aware he also had a large 9cm aneurysm that required immediate surgery.
“Pre-operative testing brought the patient’s condition to light and a plan was created to perform two life-saving operations consecutively,” says Dr Blake, who operates at St George’s Hospital. The complexity of the two operations - endovascular aneurysm repair (EVAR) and trans-catheter aortic valve replacement (TAVI) - required a rigorous hospital-wide consultation process to be carried out to ensure the best outcome for the patient. It was decided that the EVAR procedure would be completed first, followed immediately by the TAVI.
During an EVAR, a covered stent graft is placed in the aneurysmal area of the aorta. TAVI is a procedure that involves an aortic valve being implanted using a long narrow tube called a catheter. Both operations allow specialists to avoid open surgery, resulting in better outcomes and faster recovery for patients.
Dr Blake, who carried out the TAVI component of the procedure with Dr David Smyth, says there are a number of reasons for completing the two operations consecutively. “Doing the two procedures together is much more convenient and beneficial for the patient and their subsequent recovery,” he says.
“The patient’s aortic stenosis would increase anaesthetic risk for the aneurysm procedure so it made sense to do them together, especially as both are trans-catheter procedures, using the same access point through the femoral artery in the groin.”
Mr Malcolm Gordon, Vascular and Endovascular Surgeon, worked alongside Radiologist Dr Andrew Laing and their teams to carry out the EVAR.
“It went extremely well and we were delighted with the operation. The procedure certainly saved the patient’s life, as the aneurysm had a nearly 100% chance of rupture in the next year,” says Mr Gordon. Dr Blake and Mr Gordon have a track record of utilising new and developing medical techniques. Both specialists were among the first to carry out TAVI and EVAR procedures (respectively) in New Zealand.
Dr Clive Low, Cardiologist and Heart Centre Chair, says St George’s leading edge facilities provide an ideal environment for complex surgery to take place. “St George’s has built a world class intensive care unit, making it the perfect location for complex procedures such as this,” he says.
This year the Heart Centre will be celebrating 15 years of caring for Cantabrians’ hearts and their subsequent wellbeing. The Cardiology Day Unit (Cath Lab), located at St George’s Hospital, is proud to provide a wide range of routine and innovative heart health services, to suit their patients’ needs.