​

Mr Chua Wah Guan (right) with NHCS structural heart interventions director Jonathan Yap on Jan 13. ST PHOTO: MARK CHEONG

SINGAPORE - When Mr Chua Wah Guan suddenly felt unusually breathless one day while climbing up a pedestrian overhead bridge, he had no idea he would become probably the first patient in Singapore to have electrosurgery to replace a failing surgical aortic valve.

The procedure performed in May 2024 was presented at the 34th Singapore Annual Live Interventions in Vascular Endotherapy (SingLive) conference, held from Jan 16 to 18.

In electrosurgery, a high-frequency electric current is used to cut tissue, allowing precise cuts to be made with minimal blood loss.

After that episode of breathlessness, Mr Chua, 74, a retired real estate agent, found out about the failing valve during a visit to the National Heart Centre Singapore (NHCS), where he has had regular check-ups since undergoing open-heart surgery in 2011.

Such valves typically last around 12 years, after which they need to be replaced, said NHCS structural heart interventions director Jonathan Yap.

Associate Professor Yap said the replacement is often done by conducting a minimally invasive procedure known as transcatheter aortic valve implantation (Tavi).

This involves making a small incision in the groin and delivering the new valve via a catheter to the heart, implanting it on the existing aortic valve.

It was thought to be a suitable option for Mr Chua because it has lower risks of infection and other complications and a shorter recovery period, compared with a second open-heart surgical operation, which was the other option.

However, doctors found that one of his coronary arteries was positioned lower than usual.

This made a standard Tavi procedure unsuitable as the surgical leaflet – part of the valve which opens and closes to control blood flow – from his previous valve replacement could obstruct the artery as a result of the operation, posing potentially life-threatening consequences.

As an open-heart operation for older patients such as Mr Chua would also pose several challenges, including a higher mortality risk, a team from NHCS decided to use electrosurgery.

This method is also used in other instances such as for the removal of skin cancers and other growths.

In Mr Chua’s case, the electrosurgery involved inserting a very fine wire, connected to an electrical generator, into the body via a catheter to cut through the leaflet of the surgical aortic valve with precision, reducing the chance of arterial blockage.

A new heart valve was then deployed via a blood vessel in Mr Chua’s leg, while the original surgical valve was also subsequently split to create more space for the new valve to function optimally.

The procedure was a success.

Mr Chua was discharged within a few days of his surgery, and was able to return to normal activities five months later.

Prof Yap described the use of electrosurgery as a “significant leap forward” in augmenting NHCS’ ability to treat complex cardiac and structural heart cases.

“In the case of Mr Chua, the precision offered by this technique allowed us to overcome anatomical obstacles that would have been extremely risky with conventional methods,” he said.

Electrosurgery will expand the options available to heart patients, he added.

Another heart patient also had electrosurgery on the same day in May 2024, Prof Yap noted.

The two cases are believed to be the first in Singapore where electrosurgery was used to support Tavi.

Mr Chua said he was “very happy” to have gone through the procedure.

“I feel like I’ve been given a licence for another maybe 10 years or so,” he said, describing the recovery process as hassle-free.

Technologies such as electrosurgery increasingly allow for the valves of the heart to be repaired or replaced without the use of open-heart surgery, said NHCS chief executive officer Yeo Khung Keong.

But it does not mean conventional procedures for open-heart surgery are obsolete, he added.

Also featured during the conference, held at Raffles City Convention Centre, was the use of a coronary implant instead of conventional metallic stents.

Metallic stents are used to hold open narrowed arteries, but they can reduce the natural pulsing movement of the blood vessels.

In contrast, the DynamX Bioadaptor’s metallic helical strands are linked together by biodegradable parts that dissolve over a period of six months, unlocking the implant’s frame.

This allows the artery to move more freely and naturally, enhancing blood flow and reducing the risk of the vessel narrowing again.

NHCS has successfully treated some 100 patients with the DynamX Bioadaptor since it was introduced here in 2020.

This year’s SingLive conference featured the live video transmission of 27 procedures from 10 renowned heart centres across Asia and Europe. They include NHCS, National University Heart Centre Singapore, the Sapporo Heart Centre in Japan, and University Hospital UZ Brussel in Belgium.

In attendance were around 1,000 cardiologists and allied professionals.