Thailand’s elderly population is growing rapidly and the country is already considered an "ageing society", meaning 10% of the population is aged 60 and over. Meanwhile, not only elderly people but also the young generation are increasingly suffering from aortic valve disease, one of the world’s biggest killers, albeit a silent one, according to the World Health Organization (WHO).
Aortic valve disease is a condition in which the valve between the main pumping chamber of the heart (left ventricle) and the main artery to the body (or aorta) is diseased and fails to open completely, potentially leading to a life-threatening situation.
The so-called silent threat disease doesn’t show visible symptoms until the heart valve becomes damaged, leading to blood congestion in the arteries, followed by heart failure and sudden death.
To diagnose the disease, the doctor will conduct a physical examination in addition to reviewing the patient’s medical history, symptoms and their body’s readiness for operating on. Various tests are included, notably Electrocardiogram (EKG) and Echocardiogram.
Three main types of integrated treatment are currently practiced in aortic valve disease cases by the team of medical professionals at Vejthani Hospital. Two of them comprise open-heart surgery and minimally-invasive surgery (MIS) which are often performed in young patients when the narrowing becomes severe.
MIS is a newer technology for heart valve surgery that uses an endoscopic procedure that reduces the size of the incision from 20 cm to 5 cm. The scar is thus hidden under the mammary fold or in the centre of the chest, depending on the location of the valve that needs to be repaired or replaced, so the bony structure will not be destroyed. This will not only result in less incision but also cause less tissue trauma and less blood loss, which means there is less chance of needing blood transfusion. Moreover, the recovery period is shorter and the cosmetic outcome is better. Two puncture scars are left on the side of the chest each 0.5 cm wide and one scar in the groin, around 2 cm long where a catheter is inserted for the heart lung machine during the surgery.
"MIS heart valve operations have been successfully performed with patients aged from 18 to 89 years old," explains Dr. Siam Khajarern, Cardiothoracic Surgeon at Vejthani Hospital. "This even includes cases with underlying diseases such as diabetes, high blood pressure, high cholesterol, liver disease or chronic renal failure."
Minimally invasive valve replacement surgery uses new bioprosthetic valves. Daw Tin Shu, a 69-year-old woman suffering from mitral valve stenosis underwent treatment at Vejthani Hospital. She had valve surgery forty years previously, but this time she had severe mitral valve stenosis that wasn’t present before.
"Because this patient had surgery previously, there was some adhesion from the valve tissue and heart tissue in the surrounding structure," said Dr. Siam. "If we did the conventional median sternotomy, we would have to do more dissection and that would cause more bleeding. So the minimally invasive procedure was the best option for this kind of patient."
"Now I can’t feel my heart beating fast anymore when I sleep and I can get sound sleep," the patient said after undergoing mitral valve replacement. "I am eating well and can walk normally too."
The third main type of treatment prescribed by cardiologists is Transcatheter Aortic Valve Implantation (TAVI), an innovative solution for elderly patients that avoids some of the limitations of MIS. TAVI does not require open-heart surgery and is therefore more suitable and safe for the elderly as there is less blood loss.
The procedure requires careful preparation, considerable expertise and collaboration among medical professionals including cardiologist, cardiac surgeon, interventional cardiologist, anaesthesiologist, ultrasound physician, clinical nurse specialist and physical therapist.
"The big problem is that aortic valve disease never gets better by itself," explains Dr. Anurack Jeamanukoolkit, Interventional Cardiologist of Vejthani Hospital. "The critical symptoms include chest tightness, dizziness, fatigue, heart attack and inability to sleep while lying flat in bed. Over time, these symptoms increase the risk of death and deteriorate the patient’s quality of life."
Under general anaesthesia, or intravenous sedative agent, the TAVI procedure replaces the aortic valve with a prosthetic valve via a femoral artery in a leg which research indicates is the most accurate spot. The doctor starts to insert through the leg a catheter with the valve folded around it and guides it to the heart, positioning it at the opening of the aortic valve. Once it is in place, the doctor expands the valve to replace the old one.
The valve is released by expanding a balloon during angioplasty or a self-activating balloon inside the damaged valve, leaving it wrapped around the new valve without requiring its removal. The procedure normally takes two-to-three hours.
When performed by a multi-disciplinary team of doctors, the operation can be very successful. At Vejthani Hospital, TAVI is performed by highly skilled interventional cardiologists, with support from a team of specialised nurses, a cardiothoracic technologist and an anaesthesiologist backed by first-class facilities and state-of-the-art technology.
TAVI has numerous benefits. Firstly, it avoids a major open-heart operation and, as a minimally invasive procedure, causes less blood loss. The patient will only have tiny scars on both sides of the groin and a scar from a temporary central line in the internal jugular vein located in the neck.
The total length of all the incisions is no more than 5 centimetres. The patient will also have a better recovery period, a shorter duration of anaesthesia and be able to get up and walk within three-to-four hours of the surgery. Patients typically need to stay in hospital for three days for observation and recuperation and will be left with only small scarring.
Somkiat Bingasor, an elderly patient who suffered from aortic valve disease and received TAVI treatment at Vejthani Hospital, relates that, "I feel much better after the procedure. Now I don’t feel tired anymore. The feeling is incredibly good. I can go home now. I would like to thank the team of excellent surgeons. Everything here is exceptional and all the facilities are advanced technology."
"I am happy to see my father doing well. His face is bright and lively now," comments his daughter, Nijvadee Bingasor, Somkiat’s daughter. "He is physically strong and his response to the surgery is very good. He wants to start running already. It’s amazing. I’m really surprised that TAVI takes such a short time. It can be done so quickly and efficiently. From the admission day until he was discharged, we were taken good care of by the medical team of this hospital. It is an experience! And the recovery was only three days. TAVI is truly an amazing innovative treatment for aortic valve disease."
People deemed at high risk with traditional aortic valve replacement surgery, including open-heart surgery, can consider TAVI as an alternative option. However, not everyone is suitable for the treatment. You can consult a cardiologist at Vejthani Heart Center at Vejthani Hospital for further information on TAVI and aortic valve disease. Physicians and nurses at the hospital’s Heart Center are ready to help anyone worried about their heart health.
Most importantly, even with the emergence of new medical treatment techniques, self-prevention is always better than cure. Therefore, it is essential to have regular heart check-ups so that this or other diseases can be detected before they become critical.