Major milestone for pioneering heart team

23/11/22

At the age of 85, Bob Spong did not want to go through the stress of open-heart surgery.

He had been getting more tired than usual, then increasingly breathless, and tests showed his heart valves had narrowed due to calcification.

“The blood couldn’t get out of my heart because the valve was not working, which means pressure was building,” he said.

“It can lead to chest pains. I only had the breathlessness, but in the end I was so tired I was not able to do the things I normally would.”

Fortunately, Bob’s arteries were still sufficiently healthy so he was able to avoid an open-heart operation, which would require a stay in an intensive care unit (ICU) and up to two months recovering from the chest and breastbone wounds caused by such a procedure.

Instead he was able to undergo a minimally-invasive surgery called TAVI – Transcatheter Aortic Valve Implantation – at Melbourne’s Epworth Richmond.

It was the first private hospital in Australia to perform the procedure, back in 2010, and 12 years later it has reached the milestone of 1,000 TAVI cases.

Associate Professor Tony Walton, who set up the Structural Heart Program at Epworth, repaired Bob’s damaged valve by inserting a catheter via an artery accessed through a small cut in the groin. 

“I was awake the whole time, listening to all the people in the operating theatre,” Bob said. 

“There were so many people in there – about 12, including nurses, anaesthetist, surgeon, ultrasound people all working busily – it was like a beehive of activity.

“The procedure took just one and a half hours. I had it on the Monday and went home on the Thursday.”

A/Prof Walton said Epworth, as well as being the leading private TAVI provider, had an active research program to improve patient outcomes, having partnered with Cabrini Health and The Alfred Hospital.

“This provides a perfect platform for collaboration and makes us leaders across all of Australia and New Zealand,” he said.

Demand for the procedure has been rising steeply – Epworth Richmond’s specialists performed 13 TAVI cases in 2010, and 25 the following year.

“We now perform more than 150 TAVI procedures each year,” Director of Clinical Services Kate Steen said.

The program was initially limited to high-risk patients with severe aortic stenosis, who were thought to be not well enough to survive open-heart surgery, but it is now available to intermediate and low-risk candidates.

Epworth HealthCare’s Structural Heart Coordinator, Diana Lee, said the TAVI valve was also an option for people who have previously had open-heart surgery and now have failing tissue valves.

“Generally, patients and their families would prefer TAVI to open-heart surgery if they are eligible,” she said.

“With TAVI, the patient recovers quicker and can go home quicker, avoiding a stay in the ICU and a longer rehabilitation compared to open-heart surgery.”

Bob, a father of two daughters, is convalescing at home with the support of his wife.

“I stayed in bed after the procedure on Monday, Tuesday I felt washed out, and on Wednesday I felt marvellous,” he said.

“I’m not allowed to drive for a month or do anything strenuous, so my wife has to do the housework now – which she doesn’t appreciate!

“I’ll be able to catch up on my reading.”