Cardiac service pioneered at Morriston clocks up 1,000th patient and wins UK recognition

A service pioneered in Wales at Swansea’s Morriston Hospital has now treated its 1,000^th patient – and received a national award.

In 2009, Morriston became the first hospital in Wales to introduce transcatheter aortic valve implantation – TAVI.

This is a minimally invasive alternative for people who are unable to have traditional open-heart surgery for aortic valve replacement.

In the years that followed, scores of successful TAVI procedures were carried out.

However, in 2018 it became apparent that a number of patients had died while on the lengthening waiting list for the procedure.

The health board set up a dedicated group to oversee improvements in the management of the service, and commissioned an external review by the Royal College of Physicians.

An action plan was then agreed to meet the RCP’s recommendations.

Since then the TAVI service has gone from strength to strength. Today it treats more patients than ever – recently clocking up its 1,000^th procedure – and waiting times are significantly lower.

Consultant cardiologist Dave Smith (left) said: “When we started, we were doing somewhere between 20 and 30 a year for the first few years.

“It wasn’t commissioned. It was done really as a bolt-on to existing workload within the department.

“Last year we did 216 cases. So there has been a huge increase in volume. In fact, last year we did more TAVI procedures to replace diseased aortic valves than we did open heart operations for the first time.

“So we’ve gone full circle, from being a small, low-volume procedure to now becoming a mainstream, everyday treatment for patients.

“Our population in South West Wales are older than the UK norm, and often have co-morbidities – other serious conditions. We’re hopefully supplying them with the treatment they need, in greater number.”

And while the number of cases has dramatically increased, the length of time from referral to treatment has fallen significantly.

“Not only are we doing more, we’re doing them in a timelier fashion and that makes a big difference,” said Professor Smith.

“If you treat people sooner, they have better outcomes. If you make people wait for longer, they have worse outcomes.

“TAVI is now a commonly occurring procedure, which is done promptly and with good results.”

Sometimes the aortic valve, which controls the flow of blood from the heart to the rest of the body, becomes narrow because of disease.

Known as aortic stenosis, it restricts the blood flow and the heart is put under additional strain as it has to work harder to overcome this.

Symptoms can include shortness of breath, chest pain, and fainting. If left untreated, aortic stenosis can eventually cause the heart to fail.

The only long-term treatment is valve replacement. Traditionally, this was done through open heart surgery, and the cardiac surgeons at Morriston have had excellent results even in very elderly patients.

But some people are unsuitable for open heart surgery, often due to other conditions making it riskier or reducing the chance of successful recovery.

TAVI is a good alternative for these patients. It is minimally invasive and does not involve general anaesthetic – which is why TAVI, unlike a lot of conventional surgery, was able to continue throughout Covid.

Consultant cardiologist Professor Alex Chase said the Morriston service had grown and matured over the years, with the team having developed new skills.

“We used to have a team of surgeons in the room. Now it has been phrased “TAVI-light”. There are just two doctors, two nurses and the supporting team – so a radiographer and a physiologist,” he said.

“Our average time to replace a valve is now less than the average time to treat a heart attack – around 55 minutes to an hour. We are very proud of what we have achieved.”

And the good news continues. Earlier this year, 61-year-old retired oil rig worker Martyn Hughes, from Llangennech, became the first person in Wales to have a TAVI procedure and return home the same day.

Since then, the service has been presented with the prestigious Edwards Lifesciences benchmark award – making Morriston only the 9^th out of the UK’s 43 cardiac centres to gain this status.

The Edwards Benchmark programme focuses on 14 evidence-based TAVI best practices across the whole patient pathway and challenges the multi-disciplinary heart team to adopt best practices from referral to treatment.

It also allows centres to network and share learning, to keep innovating and provide the best possible care for their patients.

Professor Smith said the award was recognition of the quality service the Morriston team provided. “Every year we compare our results with the rest of the UK and ours are better than the UK average.

“We constantly have a desire to provide not just quick, timely care, but high quality care, and those things go hand-in-hand.

“At the end of every year we produce a full audit that compares our performance with that of our UK peers.

“That will always continue, because this isn’t us saying we’ve cracked it, it’s us striving for the marginal gains. We’re always looking to eke out little improvements in every part of the service.”