Professor Pandula Athauda-Arachchi

A New Lease of Life with TAVI Artificial Heart Valve Procedure at Durdans Heart Centre.

Admin — Mon, 28 Jun 2021 14:03:19 +0000

The thought of undergoing open-heart surgery for heart valve replacement can be daunting, even for a very fit patient. There is no doubt, for the elderly patients or those who already had previous operations, or those with previous strokes, lung disease, kidney disease, general frailty, open-heart surgery comes with a lot of risks, during and after the surgery. Every year, many such patients who need an aortic valve replacement, are deemed to be of high risk, will be turned down for open-heart aortic valve replacement surgery and eventually end up with prolonged heart failure or sudden death.

Due to innovation and progress in the medical industry and skilled medical specialists over the last few years, this unmet need for high-risk valve replacement has become simpler and safer with the use of TAVI (Transcatheter Aortic Valve Implantation).

Under the guidance of Dr Pandula Athaudarachchi, who has trained for many years as a Consultant in the United Kingdom and many other European centres offering these sophisticated procedures, Durdans Heart Centre has reached a landmark of completing 5 such completely successful TAVI cases for the first time in the country, whilst the patient is awake and under local anaesthesia only.

Dr Pandula Athauda-Arachchi thus becomes the first Sri Lankan fully independent specialist to have implantedTAVI valves successfully this way. He also has the credit of implanting devices in two different platforms and performing Sri Lanka’s first TAVI for morphologically abnormal bicuspid valves as well as the normal tricuspid valves with the disease.

The aortic valve plays a key role in the body’s blood pumping mechanism, failure of which causes chaos in all of the vital organs. Factors such as age-related wear and tear or defects from birth can cause the aortic valve to narrow, restricting blood flow which deprives the rest of the body of oxygen. Dr Pandula Athuada-Arachchi explained that the Transcatheter Aortic Valve Implantation (TAVI), with meticulous pre-planning, enabled him to replace the valve within 90 minutes in certain cases. Despite operating on high-risk individuals, it reduces the risks associated with open-heart surgery and general anaesthesia. It involves carefully choosing and placement of a balloon-expandable (MyVal or Edwards) or self-expanding (Medtronic Evolut™ R) transcatheter aortic heart valve after precise crushing off of the diseased valve leaflets.

The procedure is performed by inserting a catheter with the valve into the body through a small incision and navigating it to the affected valve, the patient remains fully conscious during the procedure, which only lasts about 90 minutes. TAVI allows for a shorter recovery time, mobilisation within 24 hrs and reduces the risk of infection, stroke, need for dependence on ventilators. Typically, despite their age or multiple medical issues, patients can be discharged from the hospital in 3 days.

Recently, TAVI was performed on two elderly patients at the Durdans Heart Centre who were extremely satisfied with their experiences.

“We are extremely happy about the procedure. I recovered quicker than I expected and Dr Pandula treated me very kindly. The doctor and I discussed concerns before the surgery and he explained everything to me. I am 75 years old now and have consulted many doctors but no one has attended to our needs in this way before. He briefed me well on the surgery and it went very smoothly. I came out of the surgery feeling good and talking like normal. The ICU and the CATHLAB services were also superb”.

– Patient.

“In 2020 my father did a routine check-up and it was found that the aortic valve was calcified and in bad condition. The doctor said that he would have about a year to live and suggested the TAVI procedure. My father is 85 years old and did not want to go through any surgery but eventually ended up doing so. My father didn’t feel anything at all during the surgery. He wanted to go to Galle Face Green just four days after the surgery! It’s like he has been given a new lease on life. He is so active and has so much energy. His overall health is improving. Everyone should know about this procedure that Dr Pandula is performing. This is a superb option for anyone who cannot undergo open-heart surgery”.

– Patient Party.

The post A New Lease of Life with TAVI Artificial Heart Valve Procedure at Durdans Heart Centre. first appeared on Professor Pandula Athauda-Arachchi.

First balloon expandable TAVI performed with only local anaesthesia at Durdans Hospital

Admin — Thu, 10 Sep 2020 15:57:14 +0000

first-ever balloon expandable transcatheter aortic valve implantation (TAVI) – (without open heart surgery) was performed on an 82 year old patient with Ischemic Heart Disease and poor lung function by Dr. Pandula Athauda-Arachchi Resident Consultant Interventional Cardiologist of Durdans Hospital. This was the first time that a procedure of this nature was done in Sri Lanka under local anaesthetic without any complications, with the patient being fully awake.

The patient, an elderly male residing in Kandy, diagnosed with coronary artery disease and aortic valve disease, also presented breathing difficulties and had previously suffered from a stroke. The patient was deemed high risk by cardiothoracic surgeons for an aortic valve replacement and bypass operation.

Previously, the patient had had a stent placed and undergone a balloon aortic valvuloplasty (BAV) performed by Dr. Arachchi which was a temporary solution to buy more time until long term treatment was made available. The continuing deterioration of the patient’s condition prompted Dr. Arachchi to obtain permission from the ethics committee of the hospital (since it was a first time procedure) to implant a transcatheter aortic valve. Owing to the experience and TAVI accreditation gained by Dr. Arachchi as a Consultant in the UK this first time procedure was deemed possible along with the availability of the valve.

After conducting thorough TOE and CT assessments, the procedure, a minimalistic approach without any surgical input, was performed by inserting a catheter through the groin arteries under local anaesthetic only where the patient was awake for the entire procedure. Pre-dilation balloon expansion was administered, the aortic valve assembled through the aortic annulus and the valve implanted under rapid pacing. Resulting in a perfect aortic valve without any complications or bleeding during or after the procedure.

Dr. Arachchi said, “Immediately after the procedure the patient was able to perform activities such as eating, passing urine, etc., and 12 hours after the procedure patient was able to get out of bed and mobilise. The results are comparable to patients I have treated similarly in United Kingdom.” The patient’s son said: “After the procedure my father was quite ok. His recovery was fast. In the morning we walked and he told me that he doesn’t feel breathless like he used to feel earlier.”

Dr. Arachchi said, “We want to get the technology in here because there are many heart valve patients who are declined surgery due to co-morbidity. These patients can be treated with this minimalistic approach.

At Durdans, the presence of comprehensive heart teams with cardiac surgical/cardiac anaesthesia backup helps cardiac specialists boldly perform procedures like this without hesitation.”

For Durdans Heart Centre Channelling contact on 011 2 140 205.

The post First balloon expandable TAVI performed with only local anaesthesia at Durdans Hospital first appeared on Professor Pandula Athauda-Arachchi.

Durdans Hospital adapts bone marrow stem cell therapy and advanced coronary heart procedures for heart

Admin — Mon, 07 Sep 2020 08:40:18 +0000

Durdans Hospital Colombo announced two successful adaptations of bone marrow stem cell therapy in treating heart failure due to obstructed arteries, a first ever in Sri Lanka.

The hospital announced that it had used patients’ own bone marrow derived stem cells to treat heart conditions where traditional interventions were not successful or advisable. Bone marrow derived peripheral stem cell therapy, which uses the restorative and curative powers to replace damaged cells and restore cardiac function is a new medical frontier for those suffering from deadly heart diseases.

“Stem cell therapy can enhance and repair the dying heart muscle and induce new blood vessel formation while reducing immunological damage to the heart. Since 2008, medical researchers have been conducting clinical trials of this new technology for chronic heart disease and it is increasingly being recognised as a way forward in terms of regenerating the failing heart.

There is evidence to indicate a tendency of new cells to reduce immune mediated damage, increase small blood vessel regeneration and sometimes, integrate into the heart muscle by acquiring its properties,” commented Dr. Pandula Athauda-arachchi, Resident Consultant Interventional Cardiologist, who has a PhD and, is a Gates Scholar from University of Cambridge on the subject, was instrumental (along with expert support of consultant haematologists; Dr. Mala Tudawe, Dr. Ajith Kularatne and Dr. Nipunika Senadheera) in this procedure, performed at Durdans Hospital Colombo.

Durdans Heart Centre conducted its first two successful stem cell treatments on patients whose heart function didn’t improve beyond 25% following bypass surgery. The patients’ history of a previous heart attack and delayed treatment had triggered complications such as fluid accumulation in lungs and loss of appetite. However, they safely tolerated the procedures, responded well to the bone marrow stem cell therapy and show signs of improvement, the hospital revealed.

“Using a patient´s own bone marrow stem cells not only helps to rebuild the fragile and damaged tissue, but also potentially avoids the risk of having the cells rejected. It offers new hope for intractable heart failure, which kills many patients worldwide, sometimes even more than cancers, when other treatments have failed, added Dr. Athauda-arachchi.

Chronic Total Occlusions : The second patient had endured a heart attack with 100% blockade of a main left coronary artery nearly 20 years ago (chronic total occlusion (CTO), before developing debilitating symptoms due to disease in the other arteries in the heart as well. However, due to the potential risk of a stroke, combined with other medical complications, cardiothoracic surgeons were unable to perform a bypass surgery on her.

Accordingly, Dr. Pandula Athauda-archchi and his team from the Durdans Heart Centre successfully unblocked all the arteries including the 20 year old blockade in this particular case, all under local anaesthetic, with no complications. Successful treatment in difficult situations such as this is a rare occurrence made doubly so by the patient’s minimal 48 hour stay at the hospital.

Left main coronary calcification Rotablation: The third patient suffered 90% blockade with atheroma and heavy calcium deposition of the left main coronary artery itself and at the age of 84 years, she was not fit for a bypass operation.

Dr. Athauda-arachchi used a high speed drilling of calcium (Rotablation ) of left main coronary and on both daughter vessels (a very high risk procedure) on this particular patients and successfully stented the artery, under local anaesthetic without any complications.

This case was presented to an international audience at the Euro PCR Intervention Congress held in Paris recently.

The Euro PCR is an annual event where interventional cardiologists throughout the world share their stories, breakthroughs and ideas in the hope of translating new scientific knowledge into meaningful advances in patient care.

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