Members of the ACI team for the first CAVI event in the Caribbean at West Shore Private Hospital.  Photo courtesy ACI.  -
Members of the ACI team for the first CAVI event in the Caribbean at West Shore Private Hospital. Photo courtesy ACI. –

Patients with severe tricuspid regurgitation have no other option than open heart surgery for their critical patients in TT.

The Advanced Cardiovascular Institute (ACI) has brought together a multi-disciplinary team that has successfully performed minimally invasive, non-surgical cardiac procedures to treat valvular disease and evaluate candidates.

Christopher Kamacho, director general of TCCI and MRI, was pleased to learn that patent licenses should not be used abroad.

“This is personal to me because my mother has a heart attack. When I was in the heart room I saw a patient who was very close to me – I know local and international surgeons – but there was no alternative but to her. She could not replace her valve.

Christopher Kamacho, Managing Director of the Institute of Advanced Cardiovascular Medicine, is proud that non-surgical cardiac procedures can be performed in TT. – Jeff K. Myers

“So it’s important to see how a growing number of patients like my mother are now maturing in Trinidad where they have options.

The process was successfully completed on November 30, 2021 at West Shore Private Hospital in TT and the Caribbean. The medical team was co-founded by Dr. Ronald Henry, Founder and CEO of Cardiovascular Cardiology and Cardiovascular Associations Limited; And Dr. Prasent Vijanat, a renowned cardiologist from India, trained by CAVI instrument manufacturers; Anesthesiologist Dr. Sheldon Olton and cardiologist Dr. Wazir Mohammed.

It was performed on a patient suffering from severe tricuspid regurgitation – a condition of the heart valve associated with severe heart failure – and the patient was showing promising results after six months of treatment.

The CAVI procedure involves the occurrence of two valves through a small piece in the large upper thigh. Under X-ray guidance, they are operated using catheters and guide wires, all of which are performed in a special system catheterization laboratory.

Some people suffer from valvular disease due to age or various diseases. The valves in the heart ensure that blood flows in one direction and at the right time. These valves may cause the blood to go in the wrong direction or start to flow, or it may not open properly so blood flow will be reduced.

Tricuspid regurgitation is the upper right ventricle of the heart that causes blood to flow backwards during contraction of the right ventricle. This leads to recurrent right heart failure, excessive abdominal swelling, liver congestion, leg swelling, digestive problems and chronic fatigue.

Typically, treating valvular disease involves an open heart surgeon, a fracture of the chest, stopping the heartbeat, placing the patient on a ventilator, opening the heart to enter the valve, or repairing or inserting an artificial organ. Close the valve, and close the heart and chest, allowing the patient to recover longer.

The heart diagram shows the direction of the organs and the direction of bleeding. –

“That process is very invasive and patients are not able to perform surgery when their valve status has increased to a certain extent and they have other concomitant diseases. Try to give them the best possible care.

Kamacho said the CAVI is a procedure similar to the one used for implantation of the aortic valve (TAVI) in the left ventricle of the left ventricle. In TAVI, a new, artificial valve is placed in the old valve via a catheter. After the new valve expands, it removes the old valve leaflets from the roadway and the tissue in the replacement valve controls blood flow. Now, in many cases, it is a level of care for someone with a bad aortic valve.

“With the success of TAVI, researchers have been looking at other valves, but all of them are complex and make it difficult, especially if they are not designed in this way.

“The tricuspid valve is not particularly suitable for the same approach as the TAVI and it took them a while to find out. Leave that valve in the heart because it is difficult to replace that valve and place two main inlet valves on the lower and upper blood vessels to prevent blood from going wrong. They save.

The TricValve system process with CAVI was developed by a German company. It received European approval in May 2021 and US approval in January 2022 but is still being tested.

The ACI program, in collaboration with Vaijyanath, said the patient was not a good candidate for conventional valve replacement surgery due to a number of related diseases and that he should use CAVI. After evaluation, the ACI medical team decided that the patient would be suitable for the revolutionary new procedure.

Vigilantes called on the manufacturers in India to release the valve to TT with “compassionate use” (the patient had a fatal condition and had no other choice).

A few days after the procedure, the patient underwent a screening and rehabilitation process for six months before confirming the results. Now, after six months of discharge, the patient continues to show significant improvement in symptoms and requires much less medication.

“This little TT is one of the few times that a process has been done before the US. Most importantly, it highlights our programs at ACI in West Shore. We entered this structured cardiology forum with Dr. Practition Vijanat. We have developed a number of TAVI cases highlighting the partnership and success of an international expert working with local experts to successfully transfer technology.

Dr. Ronald Henry at the West Shore Hospital Advance Cardiology Institute. – Roger James

Henry, who is credited with pioneering cardiology in the Caribbean, says that the left ventricle is the site of high blood pressure, which carries oxygen from the lungs to the body. Meanwhile, the right side of the heart receives oxygen from the body and sends it to the lungs for oxygen. The right side was a low pressure circuit with low pressure and tears so any issues there were not natural.

“What happens when the valve goes down? These people often get very sick. There are other problems that cause the valve to leak. It is not a natural disorder.

Surgeons say that tricuspid valve surgery is always a challenge because it puts the valve back in place or replaces it. Both did not produce satisfactory results.

He said the CAVI system would be more practical for this part of the world by comparing the cost of other treatments with their expensive equipment, tools and overcrowding. Those treatments, he said, were inaccessible to the average patient in the Caribbean.

However, CAVI, TAVI, and stent placement generally use the same catheterization laboratory, equipment, and skill sets if there are differences in each procedure.

“The big change is that the structural approach to heart disease is now collaborative. You need to find surgeons, intervention cardiologists, anesthesiologists, radiologists, everyone, everyone who works in one case laboratory.

Even before the patient enters the procedure, the team said it needs high speed and high CAT scans to analyze the arteries and veins and use 3D reconstruction technology. They also had to take measurements about the size of the valves so that they could cooperate with the manufacturers. And because the valves were made in the heart of a cow from Brazil in Germany, it was a short time before he was born.

He added that the valves were constantly evolving, which is not surprising because while there were generally “revolutionary” aspects of medical care, there was a period of rapid evolution in the early stages, which increased over time.

“This is a time of development in which the structural heart disease is characterized by explosive knowledge. Every year new things come out. It is a very exciting and comforting time for those who have no choice before.

Listen to a question from Dr. Ronald Henry, a member of the team at the Pre-Cardiology Center. – Roger James

Henry CAVI said it was not standard because there were no long-term randomized trials or 20-year data comparisons. Therefore, for now, it is used only on people who have had severe, life-threatening discharges, failed medical therapy and no other options.

He said that small fluids responded well to medicine, so a small number of people with valvular disease had severe leaks in the tricuspid valve. However, the ACI team was in the process of screening patients but none of them should be selected yet.

“After 15 to 15 years of long-term follow-up studies, one may be able to present it at the previous level.

Kamacho reminded that the CAVI system is still young and still relatively expensive. But he predicts that as technology advances and there are more competitors in the market, prices will drop.

“I am proud to say that Trinidad has led the English-speaking Caribbean in cardiology, electrophysiology, and now I am happy to see that being done with this group in a structured cardiac forum.”

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