Emirati woman undergoes first-in-region heart surgery

By Angel Chan

ABU DHABI 28 September 2017: Physicians at Cleveland Clinic Abu Dhabi have successfully performed a trans-catheter double-valve procedure in a clinical first for the region.

Maryam Abdallah, a 68-year-old UAE national suffering from valvular heart disease, high blood pressure, diabetes mellitus, and a range of related conditions, was transferred to Cleveland Clinic Abu Dhabi for treatment for severe aortic and mitral stenosis and recurrent decompensated heart failure, said Wam.

Having been treated in 2012 and given a heart valve to help manage her condition, the patient experienced a sudden deterioration in 2016, when her heart began to fail again. Complicating things further, she had degeneration of her native mitral valve with severe mitral stenosis, meaning that both the aortic and mitral valves were restricted and not opening well.

In addition, multiple and prolonged hospitalisations for heart failure had significantly weakened the patient, restricting the range of potential treatments that could be performed safely. As a result of these limited treatment options, the patient was offered minimally invasive, valve-in-valve Trans-catheter Aortic Valve Replacement, TAVR, and trans-catheter treatment of her mitral valve.

TAVR is a minimally invasive procedure that offers high risk patients an alternative to standard open-heart surgery. This patient presented a unique challenge as she had two separate valve disorders and required valve-in-valve trans-catheter valve replacement for the degenerated aortic valve prosthesis, as well as Trans-catheter Mitral Valve Replacement, TMVR, using a trans-catheter valve in the native mitral position.

High-risk Patient

Rakesh M. Suri MD, chief of staff and chief of thoracic and cardiovascular surgery at Cleveland Clinic Abu Dhabi, explained, “The patient was too high-risk for surgical intervention due to her health issues and more importantly due to the nature of her valve disease. Instead, a multidisciplinary heart team made the decision to perform a trans-catheter double-valve procedure, placing a new valve within the existing aortic valve and another valve in the native mitral position, all performed via a small incision in her chest, in order to save her life and improve her quality of life.”

Using innovative Cardiac Computed Tomography, CT, software, the team was able to construct a three-dimensional model to help determine the size and position of the planned trans-catheter aortic and mitral valves. More importantly, the team was able to simulate placement of the valves prior to surgery in order to plan the procedure accordingly.

Ahmad Edris MD, staff physician in cardiovascular medicine and interventional cardiology at Cleveland Clinic Abu Dhabi, explains the importance of this case, “This was a complex procedure that required a lot of planning and could only be addressed by an international, multidisciplinary heart team that Cleveland Clinic Abu Dhabi was able to call upon.”

Collaborative Effort

“The surgical intervention was successfully performed in a hybrid operating room by a team of physicians from the Heart and Vascular Institute and required the collaborative effort of several physicians. The preclinical team worked on scenarios for approximately two weeks ahead of surgery, drawing on international expertise, and we were able to deploy the valves and the technology to make the operation possible,” said Dr. Suri.

Cleveland Clinic Abu Dhabi’s access to international expertise is bolstered by its strong partnership with the US-based Cleveland Clinic, whose heart programme has ranked as the best in America for 22 consecutive years by U.S. News and World Report’s “Best Hospitals.”

“In previous years, this patient would have needed to travel overseas to one of a handful of elite hospitals to manage her condition. Today, we have the expertise and the critical care facilities to perform these operations much closer to home. In addition, we are contributing to the development of the region’s healthcare sector by performing medical firsts here in the UAE,” said Dr. Edris.

“The patient was discharged ten days after the surgery and is making significant progress. She has endured no repeat hospitalisations for heart failure and continues to come to Cleveland Clinic Abu Dhabi for regular check-ups.”

Thank God

“I thank God for giving me the opportunity to be treated in my home country and among my family members who saw me suffering a lot before the surgery,” said Maryam Abdallah.

Cleveland Clinic Abu Dhabi’s medical staff were on hand throughout her treatment plan with doctors and nurses explaining how the procedure worked and what she could expect following the surgery and through her recovery.

“This gave us a sense of confidence and trust in the medical team. We knew that the risks of surgical intervention were high, but the risks of not performing the surgery were even higher. Furthermore, having such complex surgeries available in our home country was such a relief as my mother’s condition was so critical that she would not have travelled abroad,” her daughter said, thanking all the medical team who had overseen her mother before and after the operation with care, dedication and attention.