Thousands of Britons have leaky heart valves. Olasumbo Yates, 56, a pharmacist from London, took part in a trial for a new implant that avoids the need for open surgery, as she tells SOPHIE GOODCHILD.
While on holiday with my husband, Denis, six years ago, I had a heart attack. I was sitting in the car waiting for him to buy a coffee when I suddenly felt a burning sensation in my chest, similar to indigestion.
The pain gradually became more intense and I began to feel weak so I couldn’t get out of the car to call for help. When Denis came back, he called an ambulance, which arrived and blue-lighted us to hospital.
Olasumbo Yates, 56, a pharmacist from London, took part in a trial for a new implant that avoids the need for open surgery
A scan revealed it was a heart attack caused by a clot stopping blood flow to my heart, and I was rushed in for an emergency procedure to remove it. It was all very dramatic and scary.
Although they saved my life, they told me I had heart failure: the muscle had been damaged and it was no longer able to pump blood around the body sufficiently.
The doctors were puzzled as to what had caused the clot, as I didn’t have blocked arteries. Nevertheless, I was prescribed medicine to reduce the risk of more clots and referred to my local hospital, Guy’s and St Thomas’, for monitoring.
I went home feeling very weak and was off work for more than a year because I felt constantly tired and breathless.
Ms Yates can now socialise again and walk short distances without getting breathless
I needed help with everything — washing, cleaning and getting dressed. Denis and my two daughters became my carers.
Over the next six months or so, I had several appointments with a cardiologist to monitor my condition.
Late in 2011, a scan showed that I had a leaky mitral valve, the valve that lets blood pass from the top left chamber of your heart to the bottom one.
The heart attack had damaged the area of muscle supporting this valve, which was no longer closing as it should, so the oxygenated blood was flowing backwards and worsening my heart failure.
Doctors said I might need surgery at some point to repair the valve but, at that stage, I just needed monitoring.
Sadly, my heart health deteriorated. I developed a rhythm disorder and needed a defibrillator implant to shock it into a normal rhythm; and then I also developed low blood pressure.
By early 2016, it was completely debilitating. It could take me an hour just to get out of bed and I was breathless most of the time.
Another scan revealed the valve was leaking significantly and needed repair, but I was too ill to undergo conventional surgery where they open up your chest.
My consultant mentioned a trial of a new, minimally invasive procedure, where a tiny implant is inserted to hold the heart valve in a more normal position.
This would restore the flow of blood and improve my symptoms. I had no other options so decided to go ahead.
I had the operation in September last year under general anaesthetic. Afterwards, I noticed the difference immediately. I could get out of bed and walk around the ward. The heaviness around my chest had gone. It felt fantastic.
I still have to plan my day so I don’t over-exert myself, but I can socialise again and walk short distances without getting breathless. I’ve gone from hopelessness to looking to the future, and hope others can benefit, too.
Simon Redwood is a professor of interventional cardiology at Guy’s and St Thomas’ NHS Trust in London.
A heart attack is one of the main triggers for heart failure, which affects around 900,000 people in the UK.
Damage to the heart muscle — caused by cells dying — means it must work harder to pump blood around the body. In some cases there is damage to the vital structures in the heart, too.
If the mitral valve, which controls blood flow from the top left chamber of the heart into the large bottom left chamber (which pumps blood to the rest of the body) — becomes stretched because of this damage, it will dilate too much and leak blood. This puts extra strain on the heart and worsens symptoms such as breathlessness and tiredness.
More than 2,000 people a year undergo valve repairs and replacements on the NHS. But this is major surgery and can be high risk if the heart is badly damaged.
We are trialling several less invasive options that don’t require surgery, including transcatheter annular reduction therapy — or ARTO, which is Latin for ‘press together’ — the implant that Olasumbo had.
The anatomy of the heart is different in each patient and the mitral valve is complex. So not every patient is suitable for each procedure. By having different options, this increases the chance of more patients benefiting.
What is unique about ARTO is that it improves the function of the mitral valve by shortening the distance between the valve flaps using a tiny ‘bridge’ — a T-bar implant linked via a tiny string to a wire mesh plug.
We have performed seven of these since 2016 and are the only hospital in the UK to offer it.
The chance of bleeding and damage to blood vessels is very low compared with surgery as we don’t enter major arteries. Patients spend just a few days in hospital and can walk straight after, compared with up to three months for a full recovery after valve surgery.
The aim of ARTO is to close the gap between the valve flaps that is letting blood leak. It effectively reshapes the faulty valve back to a normal shape, so it can function better. This is better than replacing the valve, as even the minimally invasive operation requires cutting between the patient’s ribs, which comes with risks such as bleeding and infection.
The procedure takes one to two hours and we use a special X-ray to guide us throughout.
We insert two long tubes called catheters via a 5mm puncture in the neck and a 1cm incision in the right groin. These guide us as we insert a long wire through from the neck and out of the groin, passing through the left and right top chambers (the atria) of the heart. We use this as a guide for steering in the ARTO device.
The first part of the device is a 3cm piece of metal shaped like a ‘T’. This implant anchors into the wall of the heart chamber. Next we insert a wire implant which we plug into a hole we’ve made between the left and right atrium on the other side of the valve.
The plug and the T-bar are then ‘bridged’ together using a string. As we tighten the string, it brings together the two sides of the valve. Once the gap is the correct length, we cut the excess string and stitch all the components in place.
After the procedure, Olasumbo’s mitral valve leakage reduced from a severe level to mild. Hopefully her heart failure won’t worsen.
Initial results from a worldwide trial of patients who underwent the ARTO procedure show the device is safe in high-risk patients, leaks are reduced and patients have improved quality of life.
We are recruiting patients for our ARTO trial and anyone who thinks they are suitable should email email@example.com