This procedure is to bypass (skip) blockages within your coronary arteries. These arteries supply blood to your entire heart. These blockages which contain calcium & plaque are what cause your symptoms of chest pain & discomfort, fatigue & shortness of breath.

Through a midline incision on your chest & opening of the breastbone (sternum) the heart can be reached. Commonly, vein from your leg & an artery from just behind your sternum (breastbone) are used to replace these blocked arteries therefore “bypassing” these blockages. This therefore improves the blood flow to the heart muscle which in turn decreases your symptoms of chest pain breathlessness &, or fatigue. Occasionally an artery from your arm may also be used for these “bypasses”.

This procedure may be done with the help of the heart-lung machine or without (“off pump”) depending on the patient’s circumstances and the surgeons approach.

Transaortic valve implantation (TAVI) is a treatment for patients with severe aortic stenosis who would otherwise be deemed at high risk for surgical aortic valve replacement (AVR). The TAVI procedure is minimally invasive and so allows patients to recover post operatively more quickly. Following TAVI, patients are generally admitted to our coronary care unit, are able to mobilise the same day of surgery, experience minimal pain and have a short length of stay in hospital.

North Shore Private Hospital is one of only a few private hospitals that are accredited to offer this procedure and have the experience of over 200 TAVI procedures.

Structural Heart Team

The Structural Heart Team have been performing TAVI procedures since 2013 at North Shore Private Hospital. Once identified as a potential TAVI patient, a patient usually comes into hospital for a few days to conduct pre-operative tests. This Multidisciplinary Structural Heart Team then meet to determine the best treatment for the patient.

Our Structural Heart team includes:

• Professor Ravinay Bhindi & Dr Peter Hansen – Interventional Cardiologists
• Dr Chris Choong - Imaging cardiologist
• Dr Laura Ahmadry – Geriatric Physician
• Dr Peter Brady & Dr Levi Bassin - Cardiothoracic surgeons
• Dr Roger Levy – Cardiac Anaesthetist
• Alex Baer - Structural Heart Coordinator

Referrals for potential TAVI patients can be made to our interventional cardiologists or cardiothoracic surgeons, or call our Structural Heart Co-Ordinator on (02) 8425 3006. They will then make the necessary assessments and organise the TAVI workup process if appropriate.

The aorta is a major blood vessel responsible for distributing oxygenated blood to your entire body. Within the aorta is a valve which prevents blood going back towards the heart. It is made up of either 2 or 3 “leaflets” which are very thin which are responsible for coming together & forming a seal to prevent this backflow. This valve can degenerate with time & leak, & / or form calcium deposits on the leaflets. This therefore stops the valve from opening & closing properly to allow blood to flow through.

Through a midline incision on your chest & opening of the breastbone (sternum) the aortic valve can be reached & either pushed open permanently or cut out, & an artificial valve sewn in.

The valve can either be mechanical (synthetic) or tissue (human or animal). If a mechanical valve is used you will be required to take blood thinners for the rest of your life. If a tissue valve is used it will need replacing in time, anytime from 8 years onwards.

In most cases, mitral valve surgery is an open heart procedure. This means that the surgeon will open your chest (breastbone) & then your heart & remove or repair the damaged valve. If your mitral valve is damaged or diseased this will prevent how blood flows through it. Sometimes the valve cannot fully open or it can leak. Your surgeon therefore will need to either repair the valve or replace it. Many factors need to be considered to make the decision to either repair or replace your valve.

If your valve is replaced it will be with either a mechanical valve (synthetic) or tissue valve (sourced from an animal). If a mechanical valve is used you will be required to take blood thinners for the rest of your life. If a tissue valve is used it will need replacing in time, anytime from 8 years onwards.

The aorta is a major blood vessel responsible for distributing oxygenated blood to your entire body. An aortic aneurysm is a bulging or enlargement of the aorta which can occur anywhere along this large artery. The appearance of an aneurysm can be very different with ballooning or bulging out to one side or quite uniform. Occasionally aneurysms form a ‘sac’ in a weakened area of the aorta.

To repair this aneurysm, open heart surgery is required. This means that the surgeon will open your chest (breastbone) in order to access the aorta. The section of aorta that is damaged by the aneurysm will need to be replaced with a ‘graft’ which is synthetic & tubular & made of a strong woven fabric.

A minimally invasive video-assisted technique to examine the lungs and interior of the chest. Some procedures including pleurodesis, lung biopsy and lung resection may be performed using the technique.

A thoracotomy is an incision to access your chest cavity usually to access specifically one of your lungs. This incision however can also be used for other procedures to access your aorta. The incision is made along the side of your chest wall & can vary greatly in length from approximately 6cm up to about 20cm.

Lung surgery is usually to remove a section or portion of your lung or the entire lung itself. Generally described as a wedge, lobe or lung.

Depending on your clinical condition will determine how much lung is removed & why. Surgical techniques have greatly improved making lung surgery easier to access & recover from.

The lungs are divided into lobes and this operation removes the diseases part of the lung leaving the remaining lobes to expand and fill the space.

A procedure performed using minimally invasive video techniques to block nerves causing excessive sweating of the hands and arms.

A thymectomy is an operation to remove the thymus. It usually results in remission of myasthenia gravis with the help of medication including steroids. However, this remission may not be permanent.

This is the removal of a lung. Most people can function well with one lung.

A treatment for a collapsed lung where the inner and outer pleural layers are stuck together.

VATS is a minimally invasive technique that uses small incisions and eliminates the need to spread the ribs. During VATS, the surgery is performed through a one-inch incision and is aided by a miniature camera inserted through one of the three 1/4 to 1/2" incisions. The VATS approach has significantly less pain than a large thoracotomy along with a reduced hospitalization period. Patients usually do not require a stay in the intensive care unit.