14 Jul A beating heart of clinical excellence
The cardiology unit at St Thomas’ Hospital has built a truly international reputation, increasing access for patients from across the globe who may have traditionally been denied access to more conventional heart procedures, as Professor Simon Redwood, Consultant Cardiologist based at Guy’s and St Thomas’ NHS Foundation Trust, tells Jack Ball
The cardiovascular directorate at Guy’s and St Thomas’ NHS Foundation Trust is somewhat of a powerhouse in terms of its internationally renowned cardiology treatments. It combines three inter-related services – cardiology, cardiac surgery and vascular surgery – on the St Thomas’ Hospital site, home to its inpatient and day case wards, theatres and cardiac catheter labs, the majority of outpatient facilities and non-invasive investigative units. Housing a number of expert cardiac subspecialties, the department has built up a formidable international reputation – with multi-disciplinary teams of expert nurses, consultants and researchers using the latest clinical equipment – innovating groundbreaking clinical advancements to ensure the very best in comprehensive cardiac care.
“I’ve always felt a lot more comfortable bringing my patients here, partly because of the catheterisation laboratory facilities and the range of equipment we have, but also because the nursing care on the ward is excellent,” says Professor Simon Redwood, lead interventional consultant at St Thomas’ Hospital.
All private cardiac patients are housed in the Westminster Unit at St Thomas’ Hospital – situated on the 12th Floor of the hospital’s North Wing. All rooms have en suite facilities, nurse call system, direct dial telephone and televisions, with most rooms boasting views of the Thames and the Houses of Parliament that rival some of the capital’s most luxurious hotels.
Traditional heart valve surgery is normally the most effective way to treat valve stenosis (narrowing of the heart valves) or a leaky valve (where the valve does not close properly and blood leaks backwards). However, there are risk factors that could prevent a patient from undergoing these more conventional heart procedures – including age (older patients are more at risk of complications during and after surgery), those suffering from diabetes or other vascular diseases, renal impairment, lung disease, previous strokes, or other diseases traditionally associated with older people.
“TAVI [transcatheter aortic valve implantation] is a minimally invasive way of treating the valve,” Professor Redwood explains. “A valve has been developed on a scaffold support, allowing us to squash it down. So rather than being an inch in diameter, the device is about six millimetres. We then introduce it through the artery at the top of the leg, bring it into position and inflate it with a balloon.”
TAVI’s non-invasive nature also means recovery time is greatly improved, reducing the amount of time spent in hospital – particularly important for patients visiting from overseas. “A conventional procedure would take up to three months for the breast bone to completely recover,” he says. “But I’ve seen patients sitting up in bed and having a meal after a TAVI procedure.”
The centre at St Thomas’ is now the largest in the country, having dealt with more than 700 cases of aortic valve replacement using TAVI technology – due in part to the Trust’s status as one of the largest cardiac surgical groupings in the country. “Because of this volume we have permanent catheter lab staff here who are very comfortable working with complex cases,” says Professor Redwood. “This is different to some private hospitals, with only elective procedures performed on a regular basis.
“We only tend to offer these treatments to patients over the age of 70. But we’re starting to move to lower risk patients as we receive more long-term data. In my opinion TAVI will be the dominant way we treat aortic stenosis in ten years’ time. It will be uncommon, if not unheard of, to have a conventional invasive operation.”
Building upon the Trust’s groundbreaking work in TAVI, Professor Redwood now has his sights set firmly on the next generation of cardiac treatments. Named after its appearance, the ‘Parachute’ is a small device which measures 64-85mm in diameter. It is implanted in the main pumping chamber of the heart where there is damaged muscle preventing the heart from pumping blood around the body properly.
“When someone has had a significant heart attack and a large part of the heart ventricle has died, they develop heart failure,” he explains. “At this point they can get very short of breath and they become very limited in what they can do. They may be unable to walk or need help doing so, possibly requiring a motorised vehicle to get around.” Similarly to a TAVI procedure, the device is introduced from the top of the leg and fitted in the ventricle to reduce its size and allow it to co-ordinate, function and pump better. “In the cases we’ve performed there has been a dramatic improvement in patient symptoms,” says Professor Redwood. “And although it’s a very new procedure and we’re the only centre in the country doing it, the data we’ve gathered so far looks extremely promising.”
“The Parachute implant is an exciting new procedure to help people with severe heart failure,” adds Dr Ronak Rajani, fellow cardiologist and colleague of Professor Redwood. “These are patients who have received all other conventional treatments but are still significantly debilitated by their symptoms. It is bringing real benefits for our patients and we look forward to offering it to more people with severe heart failure.”
A centre of excellence
The cardiology unit at St Thomas’ Hospital is the only clinical service in the country undertaking Parachute procedures. And having already established itself as a clinical leader in TAVI, the unit is proud of its expertise in a range of services including adult congenital heart disease, arrhythmia, heart failure, inherited cardiac conditions, interventional cardiology, cardiac imaging, structural intervention and valve disease.
“Because of the volume of cases we see, we have an enormous amount of expertise when treating patients here,” says Professor Redwood. “We also have many multi-disciplinary teams (MDTs), and would never undertake a TAVI procedure without one. Our TAVI MDT includes an interventional cardiologist such as myself, cardiac surgeons, an echocardiographer who is specifically interested in the TAVI services, as well as a TAVI nurse case specialist whose job is to deal only with those patients.”
A testament to its international reputation, the unit now also runs case demonstrations of its TAVI procedures – performed in front of a live audience and streamed internationally. These demonstrations have grown exponentially, increasing from 150-200 attendees seven years ago to the most recent demonstration attracting nearly 2,000 people.
“We are now on the map as one of the leading centres in world for performing transcatheter valve implants. We’re certainly in a group of three or four units that always gets asked to transmit. And we’re starting to get international referrals because of that.”
Curated from Article – Collaborate