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The pioneering structural heart team at Macquarie University Hospital (MUH) has celebrated a major milestone, after surgeons performed its 1,000th transcatheter aortic valve implantation (TAVI) procedure.
MUH was the first private hospital in Sydney to offer the minimally-invasive alternative for heart valve replacement outside of trials, following its revolutionary introduction in France a decade earlier in 2002.
In 2012 the hospital was approached by interventional cardiologist Professor Martin Ng and cardiothoracic surgeon Professor Michael Wilson, who were struggling to find support because the treatment did not then qualify for a Medicare rebate.
The two surgeons had begun doing TAVI as a research trial procedure at Sydney's Royal Prince Alfred Hospital (RPAH) in 2009, initially funding the operations from their own pockets.
"Macquarie's commitment saved the lives of hundreds of people who had no other treatment options, and in the process, it became a world leader in this evolving field," Prof Ng said.
The procedure is a life-changer for people with aortic stenosis (AS), a common narrowing of the heart valves that leads to progressive debility.
It affects one in eight Australians older than 75, and without treatment about 50,000 people would die within five years.
Open-heart surgery to correct AS is not an option for many patients due to a combination of frailty and other health problems.
"As more people learned of this new alternative to open-heart surgery, the demand from patients for whom surgery was not an option soon overwhelmed the resources of RPAH," Prof Ng said.
MUH went on to invest more than $5 million in its TAVI program, funding between 60 and 100 procedures a year, and enabling clinical research that significantly advanced the field.
TAVI was finally included on the Medicare rebate schedule for high-risk patients in 2017, and MUH was among the first nationally-accredited centres for this work.
The rebate was extended in 2022 to cover AS patients at all levels of surgical risk, as the benefits became apparent.
Prof Ng said TAVI patients go home one to two days after the procedure, which involves placing an expandable replacement valve in the aorta using a catheter inserted into the artery at the groin.
Their recovery is also minimal, compared to days of intensive care and weeks of rehabilitation after open-heart surgery.
"By 2023, 58 percent of all aortic valve replacements in Australia were done by TAVI, and we expect this percentage to continue to grow," Prof Ng said.
"This is a serious, life-limiting condition that can now be very easily fixed, and the methods are now being applied to other heart conditions."
The MUH Structural Heart Team now has more than 50 members, including surgeons, cardiologists, cardiac anaesthetists, nursing, allied health and support staff, and performs about 250 structural heart procedures a year.
Macquarie University Hospital's doctors have also been world leaders in the understanding of AS and its treatment.
In 2021, Prof Ng published the world's largest prevalence and clinical outcomes study, providing seminal new information highlighting the serious implications of all types of severe AS.
Prof Ng and Prof Wilson have also developed and published new ways to perform TAVI that are both safer and more effective for patients, improving its delivery worldwide.
MQ Health's CEO, Conjoint Associate Professor Walter Kmet, said MUH was proud of the team's contribution to the advancement of minimally-invasive heart interventions.
"When Professor Ng and Professor Wilson first came to us, we saw this as an excellent opportunity to support an innovative new procedure that could change lives," he said.
"Our integration with Macquarie University Medical School means MUH is also dedicated to furthering medical research and innovation.
"I believe that if we had not supported the team's vision, it would have taken much longer for TAVI procedures to be included on the Medicare rebate scheme and become an option for people Australia-wide.
"It has been a pleasure to watch the Structural Heart Team grow and evolve into a large, highly-skilled group with significant expertise in complex cardiology, surgery and patient support."
Read more: 'World-class' team celebrates 500thTAVI
Read more: Major milestone for pioneering heart team
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