PARTNERS Interventional Centre of Jamaica (PICJ) has introduced a groundbreaking medical procedure that will revolutionise the treatment of aortic valve stenosis — a condition where the aortic valve in the heart becomes narrowed — in Jamaica.

The procedure, done for the first time in Jamaica on June 16, 2023 at PICJ, is called transcatheter aortic valve replacement/implantation (TAVR/I).

The procedure was led by Miami-based Jamaican interventional and structural cardiologist Dr Shaun Smithson, with cardiothoracic surgeon Dr Roger Irvine as backup.

The TAVR is a minimally invasive procedure where the aortic heart valve is replaced, not by the conventional open-chest technique on a non-beating heart but introduced from a blood vessel in the groin via a long catheter, put in position and attached while the heart is still beating.

It is done using X-ray guidance, and except for the puncture wound in the groin for the introduction of the catheter necessary for the procedure, there are no other cuts on the skin.

It can be done with only sedation, versus a surgical aortic valve replacement which requires general anaesthesia. It is a procedure indicated best for a narrowed aortic valve (stenotic) in someone thought too frail to safely undergo surgical aortic valve replacement. Most patients go home in one to two days following the procedure.

In this case, the patient was an older gentleman with multiple risk factors for a poor outcome with the conventional surgical valve replacement. The TAVR allowed the patient to have a short length of stay at the hospital and a quicker return to his normal daily activities.

“TAVR is a minimally invasive procedure and is generally preferred for higher-risk or elderly patients, while SAVR (surgical aortic valve replacement) is considered for younger and lower-risk patients. SAVR is an open-heart surgery operation where the diseased valve is replaced with a prosthetic valve. This has a higher risk of periprocedural complications, including stroke, and longer length of stay in hospital for recovery,” Dr Smithson told the Jamaica Observer.

Further, Dr Smithson said the procedure is “a complete game-changer not only for Jamaica but the Caribbean”.

“Patients will now have the option of a minimally invasive procedure that is commonly offered in more developed countries. The procedure utilises significantly less hospital resources compared to SAVR, making it more easily accessible to more patients that need to be treated,” he said.

Following the procedure, the patient was awake and arousable from anaesthesia in less than an hour after completion, and was in great spirits as he felt immediate improvement.

The TAVR improves the patient’s lifestyle by relieving symptoms associated with aortic valve stenosis.

“These include shortness of breath, fatigue, and chest pain. By restoring proper blood flow TAVR enhances physical capacity and enables individuals to engage in activities they previously found challenging. The minimally invasive nature of TAVR also leads to faster recovery times, allowing for a quicker return to normal daily activities,” Dr Smithson said.

In reference to the efficacy of the procedure, Dr Smithson added, “Prior to the commencement of the procedure I hosted a valve conference outlining the patient’s risk factors and clinical data consistent with severe aortic stenosis. During this presentation we also discussed the case plan which involves the sizing of the new valve, approach to valve implantation, and any significant areas of potential complications. Given the complexity of procedure we also ensure each member of the team is familiar and comfortable with their role and responsibilities.

“During my training at Houston Methodist Debakey Heart & Vascular Institute, one of the most renowned cardiac facilities in the world, I was privileged to be a part of some of the pivotal trials for the approval of this device. This experience has since allowed me to successfully initiate three valve programmes at hospitals in South Florida. The procedure went smoothly because of my familiarity with TAVR, in addition to comprehensive planning and adequate preparation.”

Moreover, Dr Smithson said it was a privilege for him to come back to his home country and share his expertise in this regard.

“It was a pleasure to work alongside colleagues in the local medical community and forge new relationships with international industry representatives in cardiology. I hope to continue to advance cardiac care in Jamaica and the Caribbean,” he said.

In the meantime Dr Victor Elliot, interventional cardiologist and managing director at PICJ, said, “Being able to provide this level of cardiac care has always been our goal. To see a patient do a heart valve replacement without the need for days in ICU post-recovery, awake responsive, is truly remarkable. For us, this is just the beginning.”