Ex-oil rig worker has a new heart valve fitted – and is back home the same day

A retired oil rig worker has become the first person in Wales to have a heart valve replaced and be back home the same day.

Fifteen years ago, Martyn Hughes underwent open-heart surgery to replace his failing aortic valve.

He was in intensive care for a week and took many weeks more to recover, feeling fragile and “like a box of broken eggs”.

Martyn knew the new valve would itself need replacing eventually. That day arrived this year. Only this time his experience was very different.

Instead of cutting him open, cardiologists at Morriston Hospital used a catheter, a hollow tube with a balloon at its tip, to push the new valve along an artery from his groin to his heart, placing it inside the old one.

The procedure, known as TAVI, took just an hour to complete and Martyn was back at his home in Llangennech that same night.

“It was a fantastic outcome,” said the 61-year-old, a former competitive cyclist who was still participating in challenging endurance events five years ago.

“To be back in my own bed that night was incredible. Nobody would believe me at first.”

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

Image of the TAVI valve (circled) being inserted. The wire loops to the left are from Martyn’s open-heart surgery 15 years ago

Patients usually go home either the next day or two days later, which reduces the pressures on hospital beds. Now Martyn’s day-case TAVI represents yet another evolution in the service.

And he is uniquely placed to offer a first-hand perspective on the difference between open-heart surgery and TAVI.

In 2006 he was working for BP, around 130 miles offshore in the North Sea, when he became unwell. He had to be flown by helicopter to hospital where he was diagnosed with pneumonia.

He took several weeks to recover, but a couple of months after returning to work he felt something was wrong.

He spent a month in Llanelli’s Prince Phillip Hospital being treated for endocarditis, a serious condition that affected his aortic valve.

“I was being prepped for surgery,” he recalled. “Because of my age we decided to defer it as my condition was not deteriorating. But eventually it was time to do the surgery.

“I spoke to Mr Youhana, the surgeon at Morriston Hospital, who told me I could have a mechanical valve that would never need replacing. But I would have to be on lifelong blood-thinning medication.

“With the nature of my work, isolated in the North Sea, or the hobbies I was doing – I’d been a competitive cyclist for many years in the past – the last thing I would have wanted was to have an accident somewhere while on blood thinners and be in a bit of a situation, as you can imagine.”

Eventually it was agreed to proceed with a tissue valve. Martyn was in intensive care for a week after undergoing open-heart surgery, followed by many weeks more of slow recovery.

“It was the opening of the chest, the sewing it up again after. There’s a piece of piano wire that’s still there, holding me together,” he said.

“There was that sense of fragility – the feeling that, if I cough now, something is going to happen. It was a good month before I even started moving around.

“It’s a mental barrier, holding you here. I remember thinking, I’m a box of broken eggs at the moment.”

Eventually he returned to full fitness, even completing the Ironman Wales event in Tenby in 2016 and 2017 with no health issues whatsoever.

As it was a tissue valve, Martyn knew it would need replacing eventually.

When, around 18 months ago and after contracting Covid, he felt the air in his lungs was not powering his legs as normal, his GP sent him for tests which led to him being referred to Morriston.

Although the decision was to implant another tissue valve, it was done through TAVI, in one of the Cardiac Centre’s three catheter labs.

Martyn was admitted for tests in the afternoon, before having the procedure the following morning.

“It’s fascinating. You have three TV screens in front of you and you’re watching it live. I wasn’t sedated or anything,” he said.

“There was a sharp scratch and a little bit of general discomfort as they moved the catheter around inside me. It was all thoroughly explained, what was going to happen and what I would feel at the various points.

“Because I already have a surgically-implanted valve, the new valve was going in through that so they knew exactly where to locate it.

“It was literally 30 seconds where they were saying, okay, they were happy with it. A little bit of electrical stimulus on the heart to make it flutter but not pumping blood at that point. And – bang. This new valve was in place and the various wires were redacted.

“The doctors were looking at the screen and saying it fitted perfectly; there was no seepage through the valve. It’s pumping perfectly. One said, you may even be going home today – it was that satisfactory a result.”

Martyn is now walking around freely with no discomfort, though he won’t consider resuming exercise until after his next hospital appointment when he can discuss it with the team.

“I can’t see myself doing another Ironman again but there are still plenty of things I’ve got to do. My wife and I do a lot of hill walking and cycling. We’ve walked up 40 or 50 of the highest mountains in Britain.

“I’m feeling absolutely fine. I’m sleeping well. The professionalism and care of the Morriston team was fantastic.

“I can’t speak highly enough of them.”

In 2009, Morriston became the first hospital in Wales to introduce TAVI, carrying out scores of successful procedures in the years that followed.

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.

This year the service received a national benchmark award for best practice, becoming only the 11^th out of the UK’s 43 cardiac centres to achieve it.

Consultant cardiologist Professor Alex Chase, who carried out Martyn’s procedure, said the implications of same-day TAVI were very exciting.

“Not just because of the resource implication, but also the patient experience, the outcome measure, sleeping in your own bed,” he said.

“This is opposed to having your chest opened, spending two days in intensive care, a week in hospital and probably a six- to eight-week recovery time for traditional open-heart surgery.

“However at the moment, same-day discharge is highly selective. Most of our patients are elderly with other illnesses.

“You have to be safe at every opportunity. That’s paramount. You’re not going to send someone home because it’s beneficial on resources.”