Surgeon makes replacement heart valve

The surgeon made a replacement heart valve from my own tissue - and it will last forever

Last September, Robert Holland was given a new aortic valve, using his own heart tissue. Robert 49, a carpenter and builder who lives in Herfordshire, was the third person in the world to undergo this procedure.

The heart is a muscular pump, sending blood around the body. It has four valves – two on the left and two on the right – and these prevent blood flowing in the wrong direction. If a heart valve deteriorates, because of disease, it can cause either leakage or blockage – and this can seriously affect the efficiency of the heart. A diseased valve can be congenital (present at birth) but can become a problem and be diagnosed in middle age; or it can be due to a degenerative disease, which is mostly related to age.

The most common affected valves are the mitral and aortic calves on the left side, the latter being the most frequently affected. Valves are usually replaced either with a mechanical or a biological valve. Mechanical calves are made of titanium and pyrolitic carbon, a light and resistant material. But these require the patient taking a permanent anti-coagulant, usually the blood-thinning drug Warfarin, on a daily basis.

Patients have to be checked regularly to avoid any blood clotting, which could create blocks to the brain or the new valve. Biological replacement valves, which are either heart valves taken from pigs or made from heart tissue from calves, do not require any anti-coagulant treatment because they are natural tissue. These last around 10 – 15 years. Occasionally human valves – known as homographs – are donated, but availability is very limited. There are only a few hundred donors each year in Britain; yet more than 20,000 people need replacement heart valves.

These concerns led Professor Giles Dreyfus cardiothoracic surgeon at Harefield hospital to develop a procedure where the patient’s own tissue – the pericardium – is used to create an artificial heart valve. The risks are identical to conventional replacement heart valve surgery, but the human pericardium is a good choice because there is no risk of rejection and no need for any long-term drug treatment.

As with most heart surgery, Robert Holland’s heart was stopped by using a cardio-pulmonary bypass – a heart-and-lung machine which diverts the blood from the heart as well as the lungs when he was operated on. Professor Dreyfus cut a single piece of the pericardium – about 6cm by 6cm. This was then cleaned and immersed for ten minutes in Glutaraldehyde, a solution that ‘fixes’ the tissue to keep its identical shape and size. This fix is very important, so no changes can occur later such as curling.

Professor Holland then removed the diseased aortic valve and measured the site. The pericardium, cleaned in three different baths of saline, was then cut to size in a specific way. The tricky part is in reconstructing the replacement heart valve back into the aorta in the same way, as it would be in a normal heart. The geometry of the valve is the key to making the operation work, and working three-dimensionally is a complicated procedure.

The aorta was then closed up and Professor Holland ensured that the heart was beating on its own before closing the chest, checking that the valve was working properly.

Patients can usually return home within a week, as there is no postoperative treatment. Since the success of this first operation a few more patients have recently had the same procedure and are doing very well.

Using the patient’s own tissue may well be the ideal valve if its durability is proved. It is expected that the pericardium valve will last twenty years.

The new valve surgery costs the NHS £1,200, while traditional valve surgery costs from £1,500 to £2,000.

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Surgeon makes replacement heart valve

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