Harefield Hospital, one of the first centres in the world to implant the Edwards Lifesciences® Inspiris Resilia tissue valve; estimated to last up to 30 years. This new valve is implanted in aortic valve disease patients using a keyhole technique, an approach that remains unique to Harefield Hospital as other UK centres use a more invasive approach.
The valve options available for aortic valve replacement are rapidly evolving. Harefield Hospital is one of few experienced specialist centres in the UK pioneering the new Inspiris Resilia valve; the first in a new class of resilient heart valves.
Heart valve disease is one of the most common types of heart disease and the chances of developing heart valve disease increase with age.
Around 20,000 Britons have heart valve surgery annually – and in the 30-40 per cent of cases, it is a problem with the aortic valve, which controls blood flow from the heart to the rest of the body.
The aortic valve can become calcified over time; this then restricts the valve from opening and closing properly. Or it becomes flabby and loose that blood flows back into the heart. The aorta can also enlarge and start thinning which puts it in danger of rupturing.
If left untreated, a poorly performing aortic valve can seriously reduce a patient’s quality of life and can lead to heart failure and ultimately death.
When the aortic valve function is impaired the heart has to work much harder and a patient can experience symptoms such as chest pain, tiredness, breathlessness and dizziness as not enough oxygenated blood is pumped around the body.
The faulty flaps of the aortic valve can be repaired, but often the valve is too badly damaged, so replacement surgery is necessary.
The Inspiris Resilia valve
The Inspiris Resilia is a new type of animal tissue replacement valve which overcomes two key problems with existing options – it avoids the need for blood-thinning medication as with mechanical valves and lasts much longer than other animal tissue valves.
The Inspiris Resilia is made from tissue from cow pericardium (the heart lining) and uses new anti-calcification technology which prevents the valve becomes stiff, calcified and damaged.
The new valve also has the capability for dry storage which makes it more compatible for combined aortic root replacement.
Typically, a classic tissue valve lasts 10-12 years, after which replacement is needed. The tissue valve is indicated in patients over 70 of age. Under 70-year-old patients are give mechanical valves and must take lifelong anticoagulants.
The new valve is designed to provide younger, active patients with an alternative option to mechanical valves that does not require life-long anticoagulation with blood thinners.
It is estimated to last 30 years; due to its resilience, it is intended to reduce the chance of patients requiring additional operations in later years and allow patients to remain or regain their active lifestyles and go back to physical work.
The Inspiris Resilia valve is also suitable for female patients planning to have children and paediatric patients who typically would have a mechanical valve implanted and remain on anticoagulant drugs.
Mr Bahrami commented, “We want to offer the best treatments to our patients that give them the very best long-term outcomes. We are very proud to pioneer this exciting development for young patients who need an aortic valve replacement."
"This new valve is an absolute game-changer because it lasts three times as long as conventional valves. Instead of offering an animal tissue valve only to the over 70s, we can now offer them too much younger people and spare them a lifetime on anticoagulant drugs.”
The advantages of the Inspiris Resilia valve
- The new valve is designed to provide younger, active patients with an alternative option that does not require life-long anticoagulation with blood thinners.
- The valve is estimated to last 30 years; reducing the chance of patients requiring additional operation in later years.
- The tissue itself is made from bovine pericardium specially treated so that calcium doesn’t build up as quickly as a classic tissue valve.
- The new valve structure is built over 3 semi-rings instead of the conventional 1 ring structure. So, if required, later in life the patient can have a TAVI procedure through the groin with a valve in valve implantation.
- The minimally invasive nature of keyhole surgery used to implant the valve means the patient does not have scarring along the middle of the chest.
- Recovery is quicker than a sternotomy which can take up to 8 weeks.
In total the surgery takes up-to two hours. The patient is connected to a heart-lung bypass machine which takes over the heart’s function during the operation. The aorta is opened, and the diseases calcified valve is cut away, and right valve size is selected.
The Inspiris Resilia valve is stitched into place and then the heart is started again. The aortic valve restores its normal function straight away and the patient becomes symptom-free. Most patients can go home within 5-6 days following surgery.
Mrs Nolan is a 45-year-old female who works full time in a job requiring regular overseas trips. She has always been very active and enjoys walking at least 10km on a daily basis.
In 2014 Mrs Nolan rushed to hospitals after suffering heart palpitations whilst at work; following several heart tests she was referred to her GP so that she could be monitored. For three years Mrs Nolan did not experience any further symptoms until out of the blue the palpitations began to worsen and she started to suffer from thumping pains in the chest and intense panic attacks causing her great distress. She rushed back to A&E where further scans showed she had an ectopic heartbeat caused by a bicuspid aortic valve, which was leaking. At this point she was referred to a cardiologist at her local hospital to be monitored further; but the anxiety worsened and eventually, in April 2017 she was referred to Harefield Hospital for an aortic valve replacement.
Mrs Nolan was referred to Mr Toufan Bahrami, who evaluated her case. He reviewed the classic aortic valve replacement options available, but given Mrs Nolan’s age discussed how she was an ideal patient for the first implantation of the Edwards Lifesciences® Inspiris Resilia valve, using a minimally invasive keyhole technique. Mrs Nolan felt reassured with the benefits and research Mr Bahrami presented and agreed to the Inspiris Resilia valve implantation using the mini aortic valve replacement approach.
Following the surgery, Mrs Nolan immediately felt free of previous symptoms and the thumping pain had completely gone. She was discharged within 6 days of surgery, reported minimal scarring and recovered well; returning to all of her daily activities within eight weeks. A year on Mrs Nolan is back to enjoying long walks and holidays with her family. The medical team at Harefield were extremely pleased with her post-operative recovery and agreed a transthoracic echo would be sufficient after a year to keep a check on her aortic valve replacement.
Consultant cardiac surgeon