Health City performs first TAVI operation

Dr. Chandy Abraham, Dr. Ravi Kishore, Dr. Binoy Chattuparambil, Dr. Dhruva Krishnan and Dr. Sumit Modi

Medical professionals at Health City Cayman Islands recently completed the first transcatheter aortic valve implantation (TAVI) in the country.

The complex cardiac procedure, an alternative to open heart surgery, was performed on Cayman Islands patient Dianna Merren in February. It was the first such procedure to be performed in the English-speaking Caribbean, Health City officials said.

Health City CEO Chandy Abraham said in a press conference last week that the procedure marks the establishment of a Structural Heart Disease Interventional Program at Health City, which will use the “heart valve team” concept Health City physicians have created.

The heart valve team who performed the procedure on Ms. Merren was comprised of Health City senior cardiologist Dr. Ravi Kishore, senior cardiac surgeon Dr. Binoy Chattuparambil, and assisted by senior anesthesiologist Dr. Dhruva Krishnan. The physicians were guided by Dr. Stephen Brecker from St. George’s Hospital in London.

“This is indeed a proud moment for Health City and the Cayman Islands, as successful completion of such a complex procedure speaks volumes about the capabilities of our doctors and what we have been able to achieve as a hospital in just under two years,” Dr. Kishore said in a press release. The procedure was life-changing and life-saving for Ms. Merren, 75.

“I have been very sick for a long time, so when the doctors at Health City offered me a safe solution, I was very grateful,” Ms. Merren said in a press release. “Being the first patient for this procedure made me a little nervous, but the wonderful medical team put my fears to rest, providing me with all the information I needed to understand the procedure and the risks.”

Prior to the procedure, Ms. Merren had been regularly admitted to a hospital for heart failure caused by a condition called severe valvular aortic stenosis.

According to Dr. Kishore, the aortic valve is the most important valve in the heart, as it connects the main pumping chamber of the heart, the left ventricle, to the major artery of the body, the aorta. During severe valvular aortic stenosis, blood is unable to flow freely between those two conduits and the heart becomes less efficient.

The condition usually affects the elderly, and symptoms include shortness of breath, chest pains, dizzy spells and blackouts. The condition is very serious, causing recurrent heart failure and even sudden death. People who have developed symptoms from the condition have a 50 percent chance of dying within the first two years following diagnosis, unless the aortic valve is replaced.

Typically, the valve would be replaced during a surgical valve replacement, which involves surgically opening the chest. However, many patients with severe valvular aortic stenosis, such as Ms. Merren, are deemed too high risk for open heart surgery.

The TAVI procedure, which is a minimally invasive surgery, is an alternative for such high-risk patients. During the procedure, an artificial valve is inserted through a 6mm or 7 mm opening in the upper thigh under general anesthesia.

Ms. Merren’s procedure took just under two hours, and she was discharged from the hospital within a couple of days.

“The surgery has changed my life, and I am already feeling much stronger and healthier,” Ms. Merren said.

According to Dr. Kishore, 3 percent of all people over the age of 75 and 5 percent to 7 percent of people over the age of 80 have severe valvular aortic stenosis. The cardiologist estimates there are probably 50 patients in the Cayman Islands with undiagnosed aortic stenosis.

“Considering Cayman Islands has one of the highest longevities in the world, this is going to be an important treatable problem,” Dr. Kishore said at the press conference.

Dr. Kishore said the success of the procedure “firmly establishes the competence” of Health City’s cardiovascular team in handling complex procedures, and the team plans to introduce many such complex hybrid procedures with the Structural Heart Disease Interventional Program.

Dr. Abraham said Health City is “extremely proud” of its physicians, nurses and technicians who make it possible for the hospital to offer such complex procedures that benefit individuals who are suffering.

“The most gratifying thing for us, more than the technical prowess of doing something like this, is to have made a difference to another person, and this is what exemplifies the team and the work here at Health City Cayman Islands,” Dr. Abraham said.

“Our focus is to be patient-centered and to collaborate across various specialities to improve access to advanced high-tech care in this region.”