1 December 2023

Minimally invasive heart valve surgery enables patient to recover quickly for brain op


A patient who only discovered he needed heart surgery when he was about to go under the knife for a brain operation has benefitted from a cutting-edge cardiac surgery technique which enabled him to recover quickly and undergo both operations successfully within a matter of weeks.

John Harper, 69, of Chesterfield, was in hospital to have a benign brain tumour removed when he informed the anaesthetist that he had been suffering from breathlessness.

An echocardiogram scan revealed that John, a former miner and upholsterer, had severe aortic stenosis, which is a narrowing of the aortic heart valve, and needed to have the valve replaced before he could undergo the brain surgery. Without treatment, Aortic Stenosis leads to heart failure and 50% of patients don’t live beyond two to three years.

Because of the need for John to recover quickly for his brain surgery, he was immediately referred to cardiac surgery and was assessed the next day for his suitability for minimally invasive surgery called an Anterior Right mini-Thoracotomy aortic valve replacement (ART-AVR). Sheffield is one of only very few UK centres that can perform this surgery, which requires only a 5cm incision on the right of the chest between the ribs, thereby avoiding cutting through the breastbone. In the majority of patients it has a recovery time of less than two weeks, compared to a recovery time of six weeks to 3 months for traditional open surgery which involves sawing through the breastbone with a long incision being made down to the top of the tummy.

A pre-operative CT scan showed that the position of John’s aorta was suitable for the ART-AVR approach, and the operation went ahead just four days later at the Northern General Hospital. The valve was replaced with a new one made from bovine pericardium (pericardium is a fibrous membrane that surrounds the heart).

John’s recovery was so fast that he was discharged from hospital three days after the surgery, and was back on his bicycle, in his allotment and at his part-time job in a shop within a week.

Two and a half months later he was able to undergo the brain tumour surgery at the Royal Hallamshire Hospital, which was also successful.

John said: “I was in hospital for the brain operation, and I was only about 30 minutes away from the surgery, when I told the anaesthetist I’d been getting breathless about four weeks before. I thought it would be something to do with the brain tumour, but they said they needed to check it out and found out I had a dicky ticker, and couldn’t go ahead with the brain op until I had the heart op.

“From there it all happened very quickly but I took it in my stride, it had to be done. It was more stressful for my wife, Janet.

“The heart surgery was nowt, just like having a tooth out. It was fantastic. I just have a couple of dots where the cut was made but the scar has healed. Within a few days I was back pottering about on the allotment and my pushbike. I feel like I did when I was 50.”
Consultant Cardiac Surgeon Mr Govind Chetty performed John’s operation.

He said: “The main benefit of the minimally invasive ART surgery is that recovery is rapid – there is no big cut, minimal bleeding and no damage to the breastbone. This means there is a shorter stay in hospital and patients can get back to normal activity quickly. For example, they can drive within two weeks and potentially be back at work as well, depending on the nature of their job.

“In Mr Harper’s case, it meant that he was able to have his brain surgery done soon afterwards. It is great to see that he is doing so well.”

Sheffield Teaching Hospitals runs a cadaveric course that teaches other surgeons the technique and other surgeons from overseas have visited the cardiac surgery unit to learn this procedure first hand in theatre.

Mr Chetty said: “We are proud to be one of the few UK centres that can offer this surgery to suitable patients and share our skills and knowledge with colleagues from other parts of the UK and the world.”

Photo: John Harper with Consultant Cardiac Surgeon Govind Chetty



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