The heart's tricuspid valve is a non-return valve in the right ventricle. In a healthy state, it prevents blood from flowing back into the body instead of being pumped towards the lungs for oxygenation. Sometimes, the tricuspid valve leaks. Only recently has it become possible to repair this defect without surgery using a catheter-based procedure from the groin with the help of an artificial heart valve. The Department of Cardiology at Düsseldorf University Hospital (UKD) is one of the world's leading centres for the use of this new technique.
It is not only in terms of the number of interventions that the UKD holds its own in comparison. There are two specialities with which the Düsseldorf heart specialists are attracting attention throughout Germany and internationally:
Intervention with sedation instead of general anaesthesia
The cardiologists at the UKD are the only centre in the world to perform many of the interventions without general anaesthesia and the necessary ventilation and instead put their patients into a pain-free twilight sleep as part of so-called analgosedation. The cardiologists' approach is now to be scientifically described as part of a case series.
Patient Ursula T. underwent the procedure without anaesthetic. “I didn't notice anything of the entire procedure and woke up happy afterwards,” says the 78-year-old. She felt a clear improvement just three days after the new heart valve was implanted. “I feel much more alert and resilient.” Ursula T. belongs to a group of patients for whom a general anaesthetic poses a considerable risk, partly due to her many years of severe heart disease with various subsequent health problems. “I was glad to hear that the procedure can be performed here in Düsseldorf without anaesthesia and ventilation,” she says.
“Avoiding a general anaesthetic is no easy task,” says Prof. Dr Amin Polzin, Head Physician of the Department of Heart Failure, Emergency and Rescue Medicine at the Clinic for Cardiology. “We have to carry out a swallowing ultrasound examination at the same time as the procedure to ensure that we place the artificial valve in the right position.” The cardiologists have to manoeuvre very precisely. Any movement by the patient can cause the procedure to fail. “Here in Düsseldorf, we have gained a great deal of experience in close cooperation with our colleagues in anaesthesiology in sedating our patients well, i.e., making them sleep deeply enough to be able to perform the procedure safely and successfully,” says Prof. Polzin. It is important that the patient's impulse to move is excluded but that their breathing functions adequately despite the deep sleep.
Valve replacement after unsuccessful reconstruction
In addition to avoiding anaesthesia, the cardiologists at the UKD are leaders when it comes to using the Evoque valve after an interventional reconstruction attempt on the original valve has already been unsuccessful. As a rule, so-called clips are used for reconstruction attempts, i.e., staples with which the heart valve leaflets are pulled closer together to repair a leak. If the clips lose their grip after reconstruction, the staples used are in the way during subsequent treatments. “In the past, there was no longer a treatment option in such cases,” says Prof. Polzin. Removal of the clips was only possible through cardiac surgery. “However, the patients concerned are often too seriously ill for this. In many cases, they would not survive open surgery.”
In the first procedure of its kind in Düsseldorf, the clips from two previous reconstruction attempts were captured as part of the catheter-based replacement of the tricuspid valve, then pressed to the edge with the artificial valve and fixed there. “I am very pleased that our interdisciplinary team in the cardiac catheterisation laboratory, in close collaboration with colleagues from the Department of Cardiac Surgery, has succeeded in opening up new treatment options for a group of patients who could previously only be offered further therapies at a significantly higher risk,” says Prof. Kelm, Director of the Department of Cardiology, Pulmonary Diseases and Vascular Medicine. According to Prof. Polzin, the aim now is to gain further experience with this type of intervention so that as many patients as possible can benefit from it.
Text/Photo © UKD