New minimally invasive heart surgery performed for 1st time on high-risk patients in Vancouver

Four patients at a Vancouver hospital have become the first in the world to undergo a new type of heart surgery.

While they all faced high risks from traditional open-heart surgery, the less invasive procedure pioneered by a cardiac surgeon at St. Paul’s Hospital had them heading home the very next day.

Vancouver resident Gordon Allan had the new surgery in January, following an initial delay due to the pandemic. Born with a congenital heart defect, the 69-year-old had a heart transplant over two decades ago. Over time, one of his heart valves stopped working properly, a condition known as tricuspid regurgitation.

“I was kind of operating with three quarters of a heart,” he said. “You’d look at me, you wouldn’t see anything...but in terms of my stamina, my fatigue, it was not good.”

Tricuspid regurgitation occurs when the valve between the two right heart chambers doesn’t close properly, allowing blood to leak backwards into the heart.

Cardiac surgeon Dr. Anson Cheung said the malfunction can cause shortness of breath, swelling in the legs, abdominal bloating, and can also affect organ function, particularly in the kidneys.

He said generally the valve is repaired or replaced.

“A regular open heart surgery would require cracking the chest open,” he said, and added all four seniors who underwent the new procedure were not candidates for that type of surgery. “They were extremely high risk due to multiple medical conditions that they have...if they would have gone for a traditional open heart surgery, they were at very high risk of either dying or suffering severe complications.”

Cheung has helped develop a new minimally invasive procedure as an alternative to open heart surgery. It involves inserting a tube or catheter through the jugular vein in the neck and using medical imaging to guide an artificial valve into place.

“This requires only a puncture in the right side of the neck,” he said. “Basically, the patient will be awake immediately after the operation, and all four patients that we have performed it on have gone home the next morning.”

Cheung said a patient undergoing open heart surgery will typically be in the operating room for about three hours, followed by a stay in intensive care and up to a week in hospital. The new procedure is about an hour and a half, and implanting the device takes about 10 to 15 minutes.

The artificial valve involved in the procedure was made available through Health Canada’s compassionate access program, for when patients have no other options. Cheung said the new surgery has been effective for the patients who have received it so far.

“The hope is that with this, we’ll be springboarding future study,” he said. “Including a trial, an international trial to get this device approved so it could benefit more patients in the future.”

Allan said felt better immediately after the procedure, and he’s looking forward to “being healthier.”

“All the people at the hospital are amazing people,” he said. “I was very grateful to come home.”