December 7, 2009

MALAYSIA: Saving lives using a breakthrough procedure

. SELANGOR, Malaysia / The Star / Lifestyle / Malaysians Abroad / December 7, 2009 Heart at work By Wong Li Za THE past year has been a marathon for Dr Ganesh Manoharan, running from one airport to another trying not to miss a flight. A consultant cardiologist at Belfast’s Royal Victoria Hospital in Ireland, Dr Ganesh has been travelling extensively worldwide teaching heart specialists a new, breakthrough procedure. Called trans-catheter aortic valve implantation (Tavi) using the Medtronic CoreValve device, it enables defective aortic valves to be replaced using a non-invasive, keyhole method. Dr Ganesh was in Kuala Lumpur recently to perform the Tavi procedure on a few patients, with local experts, at the National Heart Institute (IJN). The procedure was recorded and shown at the Kuala Lumpur Valve Summit 2009 held last week. Privilege: ‘There’s no bigger satisfaction for me than being able to go to other hospitals and centres and teaching them a technique that’s going to save hundreds of lives,’ says Dr Ganesh Manoharan Previously, treatment for patients with aortic valve defect, or aortic stenosis, was open heart surgery or a full bypass. Aortic stenosis occurs when the aortic valve narrows, obstructing blood flow from the heart into the aorta and on to the rest of the body. Causes of aortic stenosis include congenital heart defect, calcium build-up on the valve and rheumatic fever, which leads to scar tissue formation on the valve. Aortic stenosis is a serious disease predominantly in elderly patients, many who may not be able to withstand the stress of surgery. Without treatment, the average survival rate of a patient with symptoms of aortic stenosis is between two and three years, with a high risk of sudden death. The new Tavi keyhole procedure can be performed safely under local anaesthesia. A 1cm cut is made on the groin area to access a leg artery to advance a bio-prosthetic valve all the way to the heart via a catheter. “Essentially, in about an hour or so, we are able to fully replace the naturally-diseased valve with the new valve,” said Dr Ganesh, adding that the old valve is pushed aside to make way for the new one, which starts to work immediately. “What is really unique about this procedure is it has a 98% to 99% success rate,” he said. Currently, the procedure is only performed on patients who are elderly, in the high risk group for open heart surgery or too high risk for surgery. So far, the average age of patients who have undergone the procedure is 82. The first implantation in patients with the Medtronic CoreValve was done in 2004. Following a safety and efficacy study, the CE mark of approval (European approval status for clinical use) was obtained in 2007. Dr Ganesh first became involved in the procedure in 2007. Since then, he has travelled with French cardiologist Dr Jean Claude Laborde (one of the pioneers of the technique and technology) to over 100 centres in Europe, Australia, New Zealand, Canada and South America to train other doctors. “It has been a very hectic period but extremely rewarding,” said Dr Ganesh when met at his parents’ home in Damansara Heights, Kuala Lumpur. “It is a niche expertise, performed in very high-risk patients and you need a very good medical team for the procedure to be successful. “IJN has a fantastic team of people who are very motivated and experienced. I have been to many key centres around the world and I can say that IJN is among the top ones,” said Dr Ganesh, who is also co-director of the Centre for Advanced Cardiovascular Research (Royal Victoria Hospital and Ulster University) in Belfast. The Tavi procedure performed at IJN was also a first in Asia, something the Penang-born doctor is proud of. (Note: Another procedure available in certain countries, but not in Malaysia, uses a different technology but with the same objective of replacing aortic heart valves with minimal invasive technique. It is called the Edwards Sapien Valve.) “I’m from Malaysia and to be able to share something as valuable as this in the country that educated me is a special privilege,” said Dr Ganesh, whose father is an engineer in the palm oil industry. “There’s no bigger satisfaction for me than being able to go to other hospitals and centres and teaching them a technique that’s going to save hundreds of lives after that.” In 2000, Dr Ganesh also developed a novel method in cardioverting atrial fibrillation transvenously using a Passive Implantable Atrial Defibrillator. (Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body and brings on symptoms of heart palpitations, shortness of breath and weakness. Cardioverting is a procedure that converts irregular heartbeat to a normal rate.) Dr Ganesh was the first doctor in the world to show that the method and device worked. His research paved the way for a prototype device approved for clinical studies. Although in a very challenging and demanding field of work, Dr Ganesh does not wish to be anywhere else. “There’s nothing more unique than to be able to make an individual and family feel better, and that they can achieve a better quality of life from what I do,” said the eldest of three siblings. However, the father of three girls aged one, three and six hopes he will have more time to spend with his wife and daughters in the coming year. “I always feel that if you have children, you must give them the time,” said Dr Ganesh, whose wife is Irish and a clinical research nurse in cardiology at the same hospital. [rc] Copyright © 1995-2009 Star Publications (M) Bhd