news 8 Thursday April 23, 2009 TODAY
Heart valve technology
New hope for high-risk patients procedure to arrive in Singapore. “I had to
Alicia Wong
alicia@mediacorp.com.sg stop three times to rest even when I walked
100m to the market,” he recalled.
HE HAD a severely narrowed heart aortic In February, Mr Tang became Singa-
valve, but an open-heart bypass surgery pore’s first patient to undergo the treat-
15 years ago had left Mr Tang Yat Cheong ment targeted at high-risk sufferers of
(picture), 77, unsuitable for a valve replace- severe aortic stenosis, a narrowing or ob-
ment operation. struction of heart aortic valves.
“Doctors said it “I felt much better almost immediately
would be very dan- afterwards. I was alert and could breath
gerous. I was very easily,” said Mr Tang, who was discharged
scared,” he said in five days after the two-hour procedure.
Mandarin. The National Heart Centre Singapore
So, for one (NHC), the first in Asia to use this alterna-
year, he endured tive therapy called Percutaneous Aortic
constant breath- Valve Replacement, has treated another
lessness and fainting four high-risk patients. All were inoper-
spells — while able or had multiple medical problems
waiting for that magnified their risk of death if they
a new tech- underwent conventional surgery.
nology that One patient, unfortunately, died due to
would in- complications during the procedure.
volve only The new treatment, nevertheless, brings
a mini- hope to high-risk suffers of severe aortic ste-
mally- nosis. With the conventional aortic valve re-
i nva - placement operation, global statistics show
sive that high-risk patients face a 10 to 15 per
cent chance of death — compared to the
4-per-cent risk for the average patient.
Since the new procedure was devel-
oped in 2002, 6,000 such surgeries have
Alicia Wong
A mock up of the Edwards Sapien
transcatheter heart valve when deployed in a
diseased aortic valve. Courtesy NHC
been completed mainly in Europe and North
America. The failure rate — not always re-
sulting in death — is 5 to 10 per cent.
Left untreated, severe aortic stenosis
patients have a 50-per-cent chance of sur-
vival for up to two years.
More expected to seek help
Of the 50 to 80 cases NHC handles annually,
10 to 20 per cent are high-risk cases. But the
real figure could be higher, as some patients
deemed unsuitable for surgery are not referred
to a surgeon for assessment in the first place,
said consultant cardiologist Paul Chiam.
Once there is more awareness of the
new treatment, he expects an “exponential
rise” in the number of patients coming for-
ward, as has been the case in Europe.
With Singapore’s ageing population,
added Dr Chiam, “we definitely will see more
patients who are too old, too sick, or don’t
want surgery” — although a vast majority”
will still undergo conventional surgery.
In the new therapy, patients are put
under general anaesthesia and a small hole
is made at the groin or chest. A wire is passed
into the heart via an artery, and the device
— made up of a bioprosthetic tissue valve
and balloon — is placed at the diseased heart
valve to widen it. Once done, the balloon
and wire is removed. Patients are warded
for seven to 10 days post-surgery.
As for costs, a subsidised B2-class patient
would pay about $5,800 for the conventional
surgery and 10-day hospital stay.
Mr Tang paid $5,700 after subsidy for
the new therapy. This excludes the $40,000
cost of the valve, currently offered free
thanks to funding from the SingHealth
Foundation and Lee Foundation.
Still, it is “too premature” to deter-
mine if the new technique can replace the
40-year-old conventional surgery that is
the current “gold standard”, said Dr Chiam.
A United States study of high-risk patients
is testing whether the new method is “non-
inferior” to the old one.