Latest Techniques for the Treatment of Heart Valves at Hôtel-Dieu de France

A new year has begun carrying with it various challenges for hospitals and the health sector, given the difficult circumstances that Lebanon is going through. However, regardless of the prevailing socio-economic crisis, Hôtel-Dieu de France remains firmly committed to ensuring the highest quality of healthcare for its patients, and to keeping pace with the latest innovations in the medical field, therefore asserting one of its missions that calls for participating in medical advances.

Pursuant to this commitment, the Department of Cardiology at Hôtel-Dieu has maintained its excellence through its continuous achievements. The Department recently focused on keeping up with the latest progress in treating heart valve diseases. Treating or replacing the calcified stenotic aortic valve, for example, resorts traditionally to surgery, the surgical aortic valve replacement (SAVR) commonly known as “open-heart surgery”. The minimally invasive percutaneous alternative is evolving rapidly and requires modern medical technologies that rely on transcatheter aortic valve implantation (TAVI) or replacement (TAVR), as known in the United States. 

The TAVI consists on inserting the transcatheter heart valve through the femoral artery (in more than 95% of the cases) and mainly uses local anesthesia and conscious sedation to implant the new aortic heart valve inside the old one. Thanks to this technique, it has now become possible to treat aortic valve stenosis in a safe and efficient way, without the need for surgery that the patient cannot usually tolerate and that poses a significant risk to him due to his advanced age or other health problems. After this intervention, which takes around 30 to 60 minutes, the medical staff monitors the patient in the intensive or intermediate care unit (ICU) for 24 hours. In most cases, the patient could be discharged from the hospital after one or two days, at most, without experiencing any serious problems or fatigue, and he will be able to return to his regular life much faster.

However, the TAVI procedure could dislodge embolic debris that can include pieces of arterial wall, valve tissue, calcification, foreign material and both acute and organizing thrombus. Left unaddressed, the debris may cause blockages in cerebral arteries, which could lead to peri-procedural stroke. This is an uncommon condition, but it may occur in 1 to 3% of the cases, according to different studies.

Avoiding these complications may be possible today to a great extent, thanks to technical and technological advancements in the medical field and particularly with the cerebral protection system SENTINEL™, which was available for the first time in Lebanon and the Middle East and North-Africa (MENA) region.

The SENTINEL™ Cerebral Protection System, introduced percutaneously through the right radial artery, is indicated for use as an embolic protection device to capture and remove thrombus/debris dislodged during TAVI procedures. 

On Friday, January 03, 2020, the Department of Cardiology team at Hôtel-Dieu de France used the first embolic protection device in Lebanon and the region, better known as SENTINEL™, for an 83-year-old TAVI patient, with excellent results. The device is not mandatory based on international recommendations, but the medical team may suggest it to the patient in order to prevent the risk of peri-procedural stroke.

Furthermore, the transcatheter treatment of heart valves is not limited to treating the aortic valve, but also includes treating the mitral valve and atrial and ventricular septal defects, etc… In addition to the TAVI procedure, percutaneous mitral valve repair with the MitraClip™ device is also available at Hôtel-Dieu de France. This procedure provides an efficient treatment for mitral regurgitation and reflects positively on improving the patients’ quality of life and his survival rate as well.

Cutting-edge technologies for the percutaneous treatment of heart valve diseases, whether the aortic, mitral or other valves, are now available in Lebanon and performed by highly skilled and specialized physicians. This gives hope to a large number of patients who did not have previously any chance to get the necessary treatment.

Finally, the Department of Cardiology at Hôtel-Dieu de France strives to provide the most advanced and cutting-edge therapies to improve the quality of care offered to its patients. Thanks to the leading equipment available at Hôtel-Dieu and the expertise and competence of its medical team, this Department remains a leading cardiovascular institution in Lebanon and the Middle East.