MACQUARIE UNIVERSITY HOSPITAL'S STRUCTURAL HEART TEAM COMPLETE ITS 100TH TAVI PROCEDURE

 

Caption left to right: Manu Sekhar, Wendy Frazer, Associate Professor Martin Ng, Sam McKinlay, Shayna Waaka

One hundred frail and elderly patients with calcific aortic stenosis have been given a new lease on life with a minimally invasive heart procedure being performed at Macquarie University Hospital.
Transcatheter Aortic Valve Implantation, or TAVI, is a relatively new procedure in Australia. However, Macquarie University Hospital surgeons have now performed 100 of these, giving them significant experience in this complex procedure.

"This is a pioneering program for New South Wales and for Australia, for people with a life-threatening condition who would otherwise not have a treatment option,” said Associate Professor Martin Ng, interventional cardiologist who was instrumental in setting up the TAVI program at the Hospital.

“It's really revolutionary in terms of the quality of life improvements it can offer, and the number of lives it can save. These patients come to us with such shortness of breath that they can’t go about simple daily tasks. Their quality of life is very poor.”

Associate Professor Ng performs the TAVI procedures at Macquarie University Hospital along with Professor Michael Wilson, and Macquarie University Hospital remains the only private hospital in Australia with a full TAVI program. The team’s achievement of 100 procedures demonstrates that TAVI is now a well-established program at Macquarie, made possible through significant investment by the Hospital.

The procedure is complex and requires extensive resources in technology and staff to ensure good outcomes. Indeed, Macquarie established its program on the foundations of a comprehensive service, with its the Structural Heart Teams offering extremely detailed review and assessment, and a full MDT meeting every two weeks to discuss each patient in-depth.

All tests and procedures are available to the patient ‘under one roof’ and the care is streamlined and coordinated by a dedicated. Clinical Nurse Manager and Clinical Nurse Consultant. 

“We arrange everything needed for their initial assessment on the one day at the heart care centre,” said Clinical Nurse Manager Wendy Fraser. “Then, all the screening tests required at the hospital are again arranged for them on a single day. We really have refined the way we work as a TAVI team, and things now run like clockwork.

“I think our 100th procedure is a real milestone for us.”

Associate Professor Ng says that the link between the number of TAVI procedures performed and patient outcomes is clear.

“Data from the STS – the Society of Thoracic Surgeons – and the American College of Cardiology on transcatheter valve therapy in the US clearly demonstrates that the greater a surgeon's experience with TAVI, the better the patient outcomes,” said Associate Professor Ng.

“With Macquarie University Hospital having completed 100 TAVI procedures and with our data showing excellent patient outcomes, the Hospital has clearly become a centre of excellence in TAVI in Australia.”

Tuesday, October 4, 2016/Author: Bernadette/Number of views (1826)/Comments (0)/

LIFESTYLE AND LONGEVITY

by Dr Jason Kaplan

When it comes to cardiovascular health and longevity, nothing is more powerful than engaging in the simple daily activities that help people live longer and the evidence to support this is now very robust.

For people who have two major cardiovascular risk factors, the risk of having a cardiovascular event increases significantly. However, for people who have what’s called “optimal risk factors”, the risk of having a major cardiovascular event up to age 85 is actually less than 10%. When we talk about optimal risk factors, we’re talking about the big seven:

1. Non-smoker

2. Blood pressure less than 120/80

3. A healthy diet score

4. Cholesterol is less than 5 mmol /L (ideally without medication)

5. No diabetes

6. Not overweight- A healthy BMI

7. Exercise more than 150 minutes a week.

The point is that these factors are all lifestyle-related; there are no drugs involved. In fact, perhaps it’s time to return to a more hunter-gatherer sort of lifestyle and a diet high in fruit, vegetables and nuts. They had omega-3 fatty acids. They ate lean protein. They drank water and they incorporated physical activity as part of their daily routine.

Such an approach, however, must be in conjunction with low calorie intake, as the now well-known consequences of obesity include heart attack, stroke, diabetes, high blood pressure and depression. Every five kilograms people are overweight hastens a heart attack one and a half years earlier. Every five kilograms at age 21 increases the chances of someone dying before 90 by 10%.

Reviewing the American national weight control registry, for people who lost 15 kilograms and kept it off for more than a year, it’s apparent that almost all of them cut their calorie intake in half. Over 90% exercise for an average one hour a day, 75% weighed themselves more than once a week and kept track of where they were and a large majority of them watched TV for less than 10 hours a week. These are simple, practical steps that almost any patient could take.

1. FOOD

It’s becoming clearer every day that food is one of the most powerful tools for keeping the body (and especially the heart) in optimum condition. Recent literature suggests a Mediterranean style diet reduces the risk of cardiovascular events by up to 40%. 

While our bodies are not all equal, there are some fundamentals:

• Eat five serving of vegetables, two servings of fruit per day.

• Eat more fish. The DART trial looked at dietary interventions in 2,000 people who had prior myocardial infarctions. People eating at least two servings of fish a week, reduced their risk of having a subsequent event or death by close to 30%. In fact, it appears that one of the best types of diet we could recommend to someone is the ‘pesce-vegetarian’, which is primarily vegetarian with two to three servings of fish weekly.

• Eat less red meat. People who have a large amount of red meats had a 15% increased risk of having cardiovascular events.

• Avoid sugar-based drinks.

• Have a little dark chocolate. While good chocolate is often high in saturated fats and contains caffeine, there is a study that shows it does lower blood pressure and that the flavonoids in chocolate may lower LDL cholesterol. It also improves mood and happiness – which is important for longevity!

2. SUPPLEMENTS

While it’s better from the plate than from the bottle, here are a few to

Sunday, April 17, 2016/Author: Bernadette/Number of views (361)/Comments (0)/

PACEMAKERS DO MORE THAN PACE THE HEART

By Dr Edward Barin (Cardiologist)

When the first pacemaker was invented and used in man 1952, it was connected by thick wires to a battery on a trolley. Modern pacemakers are sophisticated minicomputers which can be packed into a metal box the size of a flattened walnut.  When a decision is made to implant a pacemaker, usually for a slow heart rhythm, the Cardiologist will assess a number of things. 

These include the number of wires required to maintain a normal rhythm, whether a third or fourth wire (lead) may be required, and whether the patient will need a defibrillator (ICD). A defibrillator delivers a shock to restore normal heart function should the patient suffer a dangerous heart rhythm such as ventricular tachycardia or ventricular fibrillation (cardiac arrest). 

Certain pacemakers can be programmed to deliver rapid electrical impulses to override fast heart rhythms (tachycardia) to normalise the rhythm. If the patient has weakened heart muscle (cardiomyopathy) a type of multi-lead pacemaker (biventricular pacemaker) can restore the strength and coordination of heart contractions. 

The technical name for a pacemaker is a CIED (cardiovascular implantable electronic device). This label also describes implantable devices which simply monitor the heart rhythm (loop recorder), monitor congestion due to heart failure, or deliver miniature electrical impulses to improve the strength of contraction.

Furthermore, modern pacing technology now extends to the brain, bowel, bladder, and spinal nerves. 

Macquarie Heart Clinic assesses, treats, manages and monitors patients who have CIEDs, employing the latest devices and remote (home) monitoring technologies. 
Sunday, April 3, 2016/Author: Bernadette/Number of views (344)/Comments (0)/
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THE DIAGNOSIS AND MANAGEMENT OF LYMPHOEDEMA

Swelling that persists can be difficult to diagnose. However, lymphoedema is often not considered and the diagnosis of primary lymphoedema usually presenting in the foot is often delayed for years. For patients presenting after cancer surgery and lymph node excision, the diagnosis may be relatively easy, yet early referral for treatment remains crucial. Reversal of limb volume increase and maintenance is only possible before the permanent lymphoedema-induced tissue changes of fibrosis and fat accumulation have occured. There have been recent changes in the risk and management recommendation for lymphoedema in recent times, as anaecdotal (often quite reasonable) advice has been challenged by research. 

The taking of blood pressure recordings or blood from the lymphoedema arm has not been proven to exacerbate lymphoedema. However, the use of the non-affected limb is preferred. Maintaining normal use of the affected limb, exercise including repetitive or isometric (weights) and permission to undertake activities in the heat (except saunas) or the cold are now key self-management strategy recommendations. One in six patients with lymphoedema will experience cellulitis in the affected limb usually due to Streplococcus Pyogenes, which remains sensitive to penicillin. Rapid diagnosis, early treatment and continuing a second course of antibiotics are imperative in avoiding hospitalisation. 

Complex lymphoedema therapy of skin care, decongestive massage, multilayer bandaging, exercise and ultimately compression garmenting remain the mainstay of lymphoedma management. However, providing this care in the current health environment remains a difficult task. 

Surgeries, such as liposuction, lymph node transfers and lympho-venous anastomoses are (re)emerging as complementary therapy for selected patients. The Macquarie Advanced Assessment Clinic is the only multidisciplinary Clinic available in Australia to select and provide these services embedded in a research environment. 

To find out more on the Advanced Lymphoedema Assessment Clinic please click here 

Dr Helen Mackie, Lymphoedema and Rehabilitation Specialist, 66 Rosamond Street, Hornsby, NSW 2077. Phone 02 9847 5085.

Guest Bloggers – from time to time MUH invites our specialists to provide content on our MUH Blog. Please note that with all guest bloggers the views and opinions expressed in these articles are those of the individual and are not necessarily the views of Macquarie University Hospital.


Thursday, January 15, 2015/Author: SuperUser Account/Number of views (384)/Comments (0)/
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UROLOGY: GETTING SMARTER WITH ROBOTIC TECHNOLOGY

Macquarie University Hospital has recently invested in the da Vinci surgical system, an advanced robotic surgical tool to boost the hospital’s oncology, urology and gynaecological capabilities. Our doctors will initially use this system for urological cases, with a focus on prostate surgery. However the technology will eventually be utilised by a number of specialities. Around 20,000 new cases of prostate cancer are diagnosed in Australia every year and one in five Australian men will develop prostate cancer by age 85. It is the most common form of cancer and the second most common cause of cancer deaths in Australian males.

We’re very excited about this new technology to equip our talented surgical team. The new da Vinci surgical system is a minimally invasive technique. The acquisition makes Macquarie University Hospital one of only two hospitals in Sydney to offer this unique and intuitive technology.  

Urology is one of Macquarie University Hospital’s core areas of treatment. The da Vinci Surgical System is a robotic technology that facilitates complex laparoscopic procedures. The da Vinci system provides surgeons with all the clinical and technical capabilities of traditional surgery while enabling them to operate through a few tiny incisions, smaller than a centimetre. Delicate tissue can be handled and dissected even in the most confined spaces such as the chest, abdomen and pelvis.

The da Vinci has an ergonomically designed console positioned alongside the patient, where the surgeon sits while operating. Surgeons have an immersive view of the surgical field with extremely high-definition 3D vision, allowing for precision and control. Four interactive robotic arms, which are precisely calibrated, are positioned above the patient. This technology also allows each individual surgeon’s hand movements to be scaled, filtered and translated into precise movements of the instruments that are working inside the patient’s body.  The latest da Vinci Robot also has a greater range of hand movement and visual acuity than a human hand. The high-definition 3D image provides the surgeon with unprecedented vision that enables surgical precision around vital structures. This becomes important when performing nerve sparing prostate cancer surgery.

The benefits to patients are immense. It has been well documented that patients experience a faster recovery with a reduced stay in hospital. There is significantly less post-operative pain and a lower risk of infection. Longer term results see reduced scarring and fewer post-operative complications. The Macquarie University Hospital system will be used across several areas of urological surgery. While prostate cancer will be the most common condition to be addressed, the da Vinci system will also be used to treat bladder and kidney cancer. The acquisition of the da Vinci system further enhances Macquarie University Hospital’s reputation as a major centre for minimally invasive urological surgery – with one of the key treatments of urological services being cancer. Cancer services is one of the hospital’s core areas of clinical emphasis. For further details click here

Guest Bloggers – from time to time MUH invites our specialists to provide content on our MUH Blog. Please note that with all guest bloggers the views and opinions expressed in these articles are those of the individual and are not necessarily the views of Macquarie University Hospital.


Wednesday, May 29, 2013/Author: SuperUser Account/Number of views (529)/Comments (0)/
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