GHP September 2015

ghp September 2015 | 55 health and social care Tell us more about the operation you performed on Kamil Wojniak. Bapat: Traditionally, when heart valve surgery is performed we have to split the breastbone down the middle. From there, we can then access the heart, which we connect to the heart-lung machine that, in turn, allows us to isolate and stop the heart while keeping the rest of the body alive. When the operation is complete, everything is sewn back into place, the heart reconnected and the machine removed. Alternatively, we can split the breastbone halfway, allowing us to access only the top portion of the heart – the only part needed for an aortic valve replace- ment – and we connect the patient to the heart-lung machine either through the groin, the leg muscles or the top of the chest. In my opinion, the keyhole procedure is the better option, as it does not require us to damage the breast- bone at all. We begin this procedure by analysing the CT scans and from these we can see exactly how close the aorta is to the breastbone and the ribcage. We then make a small cut of around five to seven centimetres, which allows us to enter between the ribs. By doing this, we access only what we need to and we are able to connect the patient to the heart-lung ma- chine through the arteries and the vessels in the leg. This is a very safe option when it comes to connecting the machine. It is also possible to do this through the keyhole itself, however this can raise complications as this is where we would be performing the operation. Of course, inherent in this method are a number of sig- nificant challenges. Among them is the fact that, as this is still a fairly new technique, those looking to carry out the operation must train with an expert surgeon who is experienced in performing the procedure, however, there are currently relatively few anywhere in the world. How has Guy’s and St Thomas’ Trust supported you on the road to developing and popularising this operation? Bapat: First of all, the American surgeon from whom I learned this technique came to visit me at St Thomas’ to learn the technique in which I specialise, TAVI (a heart valve procedure, involving the use of a catheter). The idea for this project started from there. Many come to St Thomas’ to watch us because the hospital is well known for being forward thinking and innovative, as well as very welcoming to over- seas experts. Following the meeting with this expert, I decided I wanted to take my team to America to learn the tech- nique. At this point, I required some funding from the hospital and some additional money from the charity and the industry. Upon returning from America, we were faced with needing to buy extra equipment – usually traditional in- struments converted with a long handle so you can oper- ate through a small hole - and this required some initial investment also. The trust very generously spent around £30,000 on buying three sets of these instruments. The Trust was more than happy to do this as they understood immediately that it was a good investment. They saw the huge potential in bringing in experts to learn this technique and realised that it would go a long way to establishing the programme, which will, ultimate- ly save lives and greatly reduce discomfort for patients. The technique seems to possess myriad advantages for patients. Why, until now, hasn’t it been more widely performed in the UK? Bapat: There are many reasons for this, one of which is that you need an experienced surgeon to take this technique on. The surgeon needs to be experienced enough both to do the operation and, if required, to call it off if they do not believe that it is progressing in a satisfactory manner. The technique also requires a great deal of skill and patience, both from the performing surgeon and their team. Every surgeon attempting this technique needs a good team who understand the procedure fully. If the team do not know the procedure well enough, it can greatly compromise the operation and reduce the chances of complete success. This is why the support from Guy’s and St Thomas’ hospital trust has been so vital. They have provided us with all the time, equipment and training we needed to ensure the project has been a success at all stages and levels of its development. Thank you for speaking to us, was there anything else you would like to add? Bapat: I think an important aspect of all this is that patients should be aware of the options open to them. We are working hard to address this issue and increase awareness through contact with GP forums, cardiologists, patient forums. Our overall aim is to increase and expand this programme, not only in St Thomas’ but in additional centres also. Earlier this year, the heart team at St Thomas’ Hospital replaced competitive strongman, Kamil Wojniak’s leaking aortic valve through an anterior right thoracotomy, a 5-6cm keyhole opening in the chest. The operation left Wojniak able to return to compe- tition without issue. We spoke to Vinayak Bapat, the trailblazing surgeon who performed the operation, to find out more about the operation and how it has paved the way for greater understand- ing of the revolutionary technique in the wider NHS.