When a Sydney grandmother needed intensive care support for her failing heart, doctors needed to act quickly.
Mary Valtas, 85, was breathless and in very poor health due to the condition of two valves in her heart which were narrowed, diseased, and worn out.
But she wasn't suitable for open-heart surgery, which she had decades before, as it was deemed too high risk.
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On Friday, she became the first person in the country to have dual valve keyhole surgery.
It involved threading prosthetic valves through the blood vessels up to the heart.
Instead of opening the chest, it only requires small incisions in the groin.
This minimally invasive technique called transcatheter aortic valve implantation (TAVI) has been used internationally for 20 years.
The difference this time is that two replacement valves were successfully inserted in the same procedure which took only 90 minutes.
"We could deliver a double valve procedure for Mary that would be safe and would turn this dire situation for her around," Professor Martin Ng, Head of Cardiology at Macquarie University Hospital, said.
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In the lead-up to the operation, the heart team had to decide whether the approach was feasible using CT scans, 3D heart models and virtual implants.
They spent many hours planning for the technical challenges of inserting two prosthetic valves that sit closely together in the heart.
Any interaction during the deployment of the implants could compromise the outcome.
The team decided the safest way to do it was to insert the aortic implant first through the artery in the leg, up to the heart.
Then, the prosthesis for the mitral valve was deployed using a different, bigger blood vessel.
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For Valtas, this novel approach was a success.
She became emotional when speaking about her recovery after spending so much time in intensive care.
"I was bed-ridden for weeks and I thought I don't want this, I'd rather die," Valtas said.
The use of keyhole techniques to replace faulty valves has grown over the years due to the ageing population with mounting evidence of the benefits and increased funding.
From July, the TAVI procedure will be available through Medicare for low-risk patients, not just those who are too sick or frail for open-heart surgery.
"That's incredibly significant," Ng said.
"We've had big randomised clinical trials, one after the other, showing that TAVI had a significant role and benefit in lower and lower risk groups."
