‘You are cured,’ is not something doctors often say to patients, least of all in an operating theatre. In this instance, not only was the patient wide awake, he had undergone a pioneering operation that would transform him from a cardiac cripple to normality in the space of a couple of hours. I went over to France to film it and experienced a little bit of history in the making.

Normal heart valves compared to aortic stenosis below
It was, by any measure, a difficult case. The Frenchman was in his early 80s, in very poor health, and it was touch and go whether the Heart Team would actually proceed. He suffered from severe aortic stenosis (AS), the most common form of heart valve disease. It’s caused by a hardening and calcification of the flaps of the valve at the base of the aorta, which becomes narrowed and leaky. Patients are severely debilitated, often reduced to a wheel chair and might drop dead at any moment.
The traditional treatment for AS is to replace the diseased valve with a tiny miracle of engineering, an artificial heart valve. These have been perfected to the point where they can restore patients to health and mobility for 20 years or more. However, valve replacement requires open heart surgery, a highly stressful operation and is not, to excuse the pun, for the faint hearted. This leaves hundreds of thousands of AS sufferers across the world who are either too frail or too poorly to have a valve replacement. In the absence of any viable medical treatment, they are simply left to die.

TAVI inserted with long blue catheter
The patient on the operating table was firmly in the high risk category for whom surgery was not an option. Fortunately for him and other AS sufferers, there is hope in the form of a new procedure that requires no surgery, not even a general anaesthetic. The patient was wide awake during the procedure and reminded us of the fact by yawning loudly from time to time. At one point, he even gave a thumbs up to the cameraman, so was clearly in no distress. What made the experience doubly exciting was that the procedure we were filming was carried out by the cardiologist who invented it, Professor Alain Cribier of the University of Rouen.
The procedure is called a Transcatheter Aortic Valve Implantation, TAVI for short. Instead of opening the heart, the valve is inserted via a catheter that is fed into the aorta from a main artery in the groin. It’s based on the procedure used for inserting stents, the tubular wire cages used to keep open narrowed arteries and veins.

TAVI is embedded in a stent
To get an idea of how difficult this is, imagine trying to fix a car engine using a probe inserted into the exhaust pipe. The procedure is carried out under X-ray and everyone in the room, including the film crew, had to wear heavy lead aprons.
The effect on the patient’s health can be dramatic. Patients once confined to a wheelchair are able lead an active life. Professor Cribier told a story of one patient who, the day after the operation, was drinking champagne and entertaining journalists in a day long series of press conferences. It’s as close to raising someone from the dead that medicine can achieve. A TAVI can take as much as ten years off a person’s life.

Professor Alain Cribier
He faced a barrage of scepticism
The success of TAVI is a tribute to Professor Cribier’s persistence in the face of a barrage of scepticism; it’s a battle that has lasted the best part of 20 years. The world’s leading cardiologists told him a valve in a stent would never work; that it was too risky; that the American Federal Drugs Administration (the dreaded FDA) would never approve, and so on. No wonder he felt ostracised. Added to that, the biomedical companies he approached to develop the valve all turned him down. I was filming on behalf of the one company that said yes; Edwards Life Sciences, who took his concept and engineered it into a viable treatment for these high risk patents. Cribier’s persistence has finally paid off and his critics muted. To date, TAVI has been shown to reduce patient mortality from AS by 20% in the first year, a significant result by any standard. TAVI is now awaiting FDA approval. Fingers crossed for Professor Cribier and the thousands of patients who will benefit from his procedure.

Michael George from Edwards Life Sciences with director for House Media, Jonathan Priest
With thanks to Professor Alain Cribier and the Heart Team at the Hôpital Charles Nicolle in Rouen, and to Edwards Life Sciences for their permission to use the image of the TAVI.