February 23rd, 2012
KITCHENER — Innovative heart surgery techniques are being pioneered by a surgeon at St. Mary’s General Hospital cardiac centre, including what’s likely the world’s first surgery through only a small chest opening.
“I think we have a little bit of a jump on everybody,” said Dr. Kassem Ashe.
Ashe developed two new surgical procedures to repair a faulty mitral valve, which opens like double doors when blood is pumped between the heart’s chambers and then closes to stop blood from flowing backwards.
Traditionally during heart surgery, a patient’s chest and rib cage is opened wide with an incision as long as 25 cm (10 inches). A newer technique uses a small incision under the breast, but that requires special tools and anesthetic techniques.
Ashe performed his version of the surgery on a patient three weeks ago using ordinary equipment and slicing an incision, at the top of the chest, only about 6.5 cm (2.5 inches) long.
“We did the first patient in the world,” Ashe said.
A surgeon needs to be experienced and the valve repair relatively simple to be done through the small opening. Advantages to the patient can be huge: including less pain, faster healing and earlier hospital discharge.
Ashe also developed a groundbreaking technique to simplify surgery for severe mitral valve problems.
There are three possible options to remedy a faulty valve. New animal tissue can be installed, but that lasts usually less than 10 years. A mechanical valve lasts longer. But blood-thinning medication is required for life, which brings an increasing risk every year of life-threatening bleeding and stroke.
Fixing the existing valve is the best way to avoid those complications.
“Nothing is better than nature,” Ashe said. “That’s what we want to repair.”
When a valve’s ‘doors’ become floppy and don’t close properly the chords attached to muscles, to hold the doors in place, need to be tightened.
Conventionally that’s a tricky surgery requiring many difficult stitches deep inside the heart that only very skilled doctors can perform, and there’s a fairly high failure rate.
Ashe’s novel approach removes the faulty doors and lifts them higher for a better seal, filling the gap with a tube he designed using synthetic material and animal tissue. Then all a surgeon needs to do is stitch the top and bottom of the tube into place.
“My procedure makes it simple,” Ashe said.
That means more surgeons will be able to repair the more serious cases once durability and success rate is proven for the patent-pending technique. Ashe performed six surgeries at the Kitchener hospital in five years since developing the tube method.
“Nobody at this point is doing it,” he said.
Terry Johannes, of Cambridge, was only the second patient to undergo Ashe’s innovative mitral valve repair, having the surgery three years ago.
“If you’re a candidate and this opportunity comes up, you do it,” said Johannes, 53.
Just a few days of considering were all he needed to agree. He was hesitant to get a mechanical valve because taking blood thinners would be risky with his physical work as an office furniture company owner, although that would have been the backup if Ashe’s new technique didn’t work.
Within months of his surgery, Johannes was back at work. Gone was the exhaustion and trouble breathing with even mild exertion caused by his severely impaired valve.
“The fact I’m on no medication amazes me,” Johannes said. “It was a much bigger win for me this way.”
St. Mary’s launched a full-service regional cardiac care centre in 2003. Its three cardiac surgeons perform about 750 open-heart procedures each year.
Johanna Weidner, Waterloo Region Record