Open heart surgery is usually performed when the valve in the artery leading from the heart needs replacing, but this is not an option for some patients. 

A less invasive procedure is now available for this minority of patients, who may have had chest surgery previously or have heart - or other - conditions that make cutting open the chest dangerous. 

For patients undergoing this two-hour procedure, doctors mount a valve on a catheter inserted into the patient's groin or chest and thread it towards the heart. 
The valve is left in place in the aorta, the artery that carries blood from the heart to the rest of the body. 

The procedure to replace malfunctioning aortic valves with a 'stent-supported valve' was pioneered in France in 2002. 

In February, Singapore become the first country in Asia to perform it. 

The valve is so called because it is supported by a stainless steel frame, or stent. 
Five procedures have so far been done, all on elderly patients, at the Singapore General Hospital's National Heart Centre. 

Doctors there are recommending the treatment only to those who have no other options or who are suffering from narrowed-valve symptoms like breathlessness and chest pain.

Left untreated, a patient in serious condition has a 50 per cent survival rate for a year or two, said Dr Paul Chiam, a consultant cardiologist at the heart centre. 

Up to 20 such patients a year now have another shot at a normal life if they undergo this valve replacement. 

The centre is not promoting the procedure to patients eligible for standard surgery, or to younger ones, as the long-term effect of the valve has yet to be established. 

For instance, it is not known if the valve will last beyond five years. 

Synthetic valves used in conventional surgery last a decade or two. 

The procedure, like any other operation, is not without risk. One of the five patients here died from a torn blood vessel. 

She was an elderly female who could not undergo conventional surgery as she had suffered earlier from breast cancer. 

The numbers here are still too small to gauge the success rate, said Dr Chiam. 

Elsewhere, 90 per cent success rates have been scored with this procedure. 

The new valve costs about $40,000 now - though the price may come down in time - compared to the $2,000 to $4,000 for a conventional valve. 

Patients undergoing this procedure can get the cost of the valves paid for by the SingHealth Foundation and Lee Foundation. They will pay only the surgical and hospitalisation bills themselves. 

The first patient to have a valve replaced under this procedure was 77-year-old retiree Tang Yat Cheong. 

He could not undergo conventional open heart surgery as he had previously undergone a heart bypass operation. 

He said of the procedure: 'It was not as scary as having a major operation. I was always breathless before the surgery, but now I feel so much better.' 

With an ageing population, the heart centre expects to see an increasing number of patients with valve problems. 

Four per cent of the people here aged over 75 are estimated to be suffering from aortic valve narrowing.

Source: The Straits Times © Singapore Press Holdings Limited. Permission required for reproduction.