In South Africa, on average 225 people’s lives are cut short by heart disease every day, according to the Heart and Stroke Foundation, and every hour ten South Africans suffer a stroke. Heart rhythm disorders, where the heart beats irregularly or too fast or slow, can affect adults or children, posing a serious health risk. Today these conditions are treatable, either with medicine, surgically implanted devices or with the aid of electrophysiology studies and ablation procedures, among others.
A pacemaker is an implanted device that helps to keep the heart pumping at a regular pace. Other treatments include medication or an implanted cardioverter defibrillator, which is a special type of pacemaker that can deliver a life-saving shock when the heart is beating too fast or irregularly.
Africa’s first structural heart centre specialising in the percutaneous repair of leaking heart valves and the minimally invasive repair of various other cardiac anatomical abnormalities was established at Netcare Union Hospital, now incorporated in Netcare Alberton Hospital, in 2014.
“One of the most important advances in heart medicine in recent years has been towards less invasive interventions, which involve smaller surgical incisions placing far less strain on the person’s system than traditional open heart surgery for appropriate cases,” Du Plessis says.
Breakthroughs in these ‘keyhole’ heart procedures have revolutionised many aspects of cardiac care. The transcatheter aortic valve intervention (TAVI) procedure replaces a diseased heart valve with an artificial one, implanted through a small incision using carefully guided catheters.
Certain patients with severe coronary artery disease require a procedure to clear a path through the artery before stents can be inserted. In a first for Africa, shockwave intravascular lithotripsy (IVL) was successfully used to ‘crack’ highly calcified deposits and blockages within the coronary arteries with ultrasound shock waves at Netcare Union Hospital, in 2019.
At Netcare Blaauwberg Hospital, the first transfemoral double valve replacement in Africa was performed earlier this year and the team of specialists at the hospital was also the first on the continent to make use of transfemoral shock wave therapy to obtain access for TAVI and to successfully perform the combination of mitral valve TAVI and coronary artery bypass surgery at the same time.
Some 15 years ago, only traditional surgical approaches were used for such procedures, however TAVI is now established at Netcare Milpark, Netcare Alberton, Netcare Sunninghill and Netcare Linksfield hospitals in Johannesburg, Netcare Unitas Hospital in Pretoria, Netcare Blaauwberg, Netcare Kuils River and UCT Private Academic hospitals in Cape Town, Netcare St Augustine’s Hospital in Durban, and most recently Netcare Greenacres Hospital in Gqeberha.
“This offers hope for many seriously ill patients, for whom traditional surgery was previously considered too high risk to even attempt. TAVI procedures can now be performed while the patient is conscious, opening this treatment modality for people who can’t have anaesthesia,” Du Plessis says.
“The effects of other health conditions on the cardiovascular system and reducing the associated heart risks through multidisciplinary care is another important emerging trend. In another pioneering cardiac development, the first cardio-oncology centre of excellence on the African continent, established at Netcare uMhlanga Hospital, recently received international certification.”
World class robotic technology offering less invasive alternatives for procedures involving the chest cavity, including lung cancer and cardiac surgeries among others, has recently been established at Netcare Christiaan Barnard Memorial Hospital. It is the first cardiothoracic robotic assisted surgery programme in Africa.
“Continuing the legacy of Professor Barnard, specialists practising at Netcare facilities, and a dedicated transplant team have been critical in adult and paediatric heart transplantation. Heart and combined heart-lung transplants are undertaken on adult patients at Netcare Milpark Hospital in Johannesburg, while paediatric heart transplants are performed at Netcare Sunninghill and Netcare Christiaan Barnard Memorial hospitals.
“Electromechanical cardiac medicine is also advancing all the time. Mechanical heart pumps, known as ventricular assist devices (VADs), have provided many desperate patients who suffer from end stage heart failure, with an invaluable lifeline until a suitable donor heart becomes available.”
South Africa’s first artificial implantation of a VAD, the Berlin Heart, took place at Netcare Christiaan Barnard Memorial Hospital in 2001. More recently, the Abbot HeartMate 3™ left ventricular assist device, implanted for the first time in South Africa in 2021, offers life-saving technology for people with end stage heart failure when a matching donor heart is not available for a transplant. This device can make it possible for patients with heart failure to regain their mobility and independence, to return to work and participate in family activities, extending their lives for many years.
“Thanks to the pioneering and dedicated specialists introducing advanced heart treatments in South Africa, and increasing public awareness of the risk factors and importance of early treatment of cardiovascular diseases, today so many people can live longer than would have been possible just a decade or two ago,” Du Plessis concludes.
