SOUTH AFRICA— The Gauteng Department of Health, has announced that the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) performed the first-ever minimally invasive sutureless aortic valve replacement on the African continent.

The surgery was led by a visiting expert, Dr. Slobodan Mićović, an Associate Professor of Surgery at the University of Belgrade Medical School in Serbia, and locally by Dr. Itumeleng Taunyane, Head of the Clinical Unit and Lead Surgeon – Minimally Invasive Cardiac Surgery and Dr. Bongani Ngutshane, Consultant Cardiothoracic Surgeon.

CMJAH is currently doing Transcatheter Aortic Valve Implantation (TAVI) for high-risk patients through percutaneous techniques, making it the only state hospital outside the Western Cape to offer the therapy.

Sutureless valves have been redeveloped in the last few years based on modern experience with TAVI and have better patient recovery outcomes than the latter.

According to the Gauteng Health Department, sutureless or rapid deployment valves in the setting of aortic valve replacement is an emerging surgical procedure using transcatheter valve technology.

The surgical procedure is used to treat aortic valve disease using transcatheter valve technology, which shortens operation time, morbidity, and length of the patient’s stay in the hospital.

In TAVI the surgeon makes a large incision in the chest to access the heart and then removes the diseased aortic valve and replaces it with a new valve.

In the newer alternative, sutureless or rapid deployment surgery, the surgeon makes two or three small incisions in the chest.

The surgeon then uses a catheter to insert the new valve into the heart and the valve is then deployed, or opened, without the need for sutures.

Consequently, because of better outcomes especially with older patients, it is becoming increasingly popular because it offers several advantages.

“One of the beneficiaries of this procedure is a 64-year-old male who was initially considered for transcatheter aortic valve implantation (TAVI), but instead, the possibility of rapid deployment valve was discussed with him, and he gladly accepted,” said the Gauteng Department of Health.

Prof Mićović is one of the world-renowned cardiac surgeons who run over 2500 cases per annum with about 705 done through minimally invasive means. 

The cardiologist expressed his satisfaction with the results of the surgery, “We operated on patients with a fantastic device with very good long-term durability. It was not complicated to implant, and it is user-friendly with very good hemodynamics.” 

An outlook of advancing improved care for aortic valve disease

The Journal of Cardiovascular Diagnosis & Therapy notes that CVDs such as aortic valve disease is unfortunately trending as a leading cause of death on the continent.

Moreover, in low and middle-income countries (LMIC) 80% of deaths are related to CVD often in young populations and it has been estimated that 8 to 9 million deaths are attributable to CVDs in the developing world.

The Journal of Thoracic Cardiovascular Surgery in 2021 further noted that specifically, aortic valve disease is endemic in sub-Saharan Africa.

Additionally, aortic valve stenosis is the most frequent cardiac valve pathology with a prevalence of 3% for individuals over the age of 75 years.

As a result, there is an increasing number of elderly patients eligible for a prosthetic aortic valve replacement (AVR) who present with greater morbidities and underlying risk factor profiles.

Based on extraordinary short- and long-term outcomes, conventional AVR (C-AVR) is the gold standard approach for the treatment of symptomatic severe aortic stenosis.

The newer aortic valve replacement with a sutureless prosthesis [sutureless aortic valve replacement (Su-AVR)] is an option for patients with severely damaged aortic valves.

The increasing incidence of aortic stenosis and greater co-morbidities and risk profiles of the contemporary patient population has driven the development of minimally invasive aortic valve surgery.

Advantages for sutureless aortic prostheses include reducing cross-clamp and cardiopulmonary bypass (CPB) duration, and facilitating minimally invasive surgery and complex cardiac interventions, whilst maintaining satisfactory hemodynamic outcomes and low paravalvular leak rates.

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