Treating your Heart Problem

Dr Sarma will spend time with you to help you understand your diagnosis.

If you need treatment, he will discuss all your options. He offers comprehensive cardiac care through careful testing, personalised treatment, and monitoring.  

As well as treating heart problems with medication (link to medications section), Dr Sarma offers minimally invasive (keyhole) interventional procedures to treat conditions affecting your coronary arteries and heart valves (structural heart disease). These treatments use imaging guidance and catheter-based techniques. Learn more about interventional cardiology services (link to procedures )

You can be referred to one of Dr Sarma’s professional colleagues, including consultants specialising in electrophysiology, cardiac surgery, or adult congenital heart disease.

Angioplasty is a procedure used to open blocked coronary arteries caused by coronary artery disease. It restores blood flow to the heart muscle without open-heart surgery. Angioplasty can be done in an emergency setting, such as a heart attack, or it can be done as elective surgery. Angioplasty is also called percutaneous coronary intervention (PCI). 

 

Dr Sarma worked with the British Heart Foundation to create a video to help explain the angioplasty procedure.

Video link: https://www.youtube.com/watch?v=6wGnLrLImto

Angioplasty opens narrowed or blocked arteries that supply blood to your heart muscle. You will be given local anaesthetic at the start of the procedure. A thin, flexible tube, called a catheter, is carefully inserted into the artery via a small incision in the wrist. A small balloon at the end of the tube is inflated to widen the narrowed part of your artery. Sometimes, a special drug-eluting balloon is used. These balloons not only stretch the coronary artery but deliver medication to the artery wall, preventing further narrowing in the future. You will be prescribed medicines called antiplatelets to decrease the “stickiness” of your blood and reduce the risk of blood clots where the artery has been stretched. 

A stent is a tiny, expandable metal mesh tube. It is put into the newly opened area of the artery to help stop the artery from narrowing or closing again.

Once the stent has been placed, tissue will start to coat the inside of the stent, like a layer of skin. The stent will be fully lined with tissue within 3 to 12 months. While this occurs, you will be prescribed medicines called dual antiplatelet therapy to decrease the “stickiness” of your blood. The medicine prevents blood clots from forming inside the stent. If blood thinners are stopped prematurely, the stent can be blocked with blood clots. This is very concerning, as it may lead to a heart attack. Following guidance on blood thinners is thus crucial to the medium and long-term success of stent procedures. In some patients, we need to modify the duration of blood thinners, especially if they are at high bleeding risk (HBR). Other patients may need more extended periods on blood thinners or require an alteration of the type of blood thinners they have been given. These decisions are made after discussions and detailed conversations with the patients, and they involve GPs and other hospital specialists.

Drug-eluting balloon angioplasty for in-stent restenosis.

Drug-coated balloons deliver drugs into the vessel wall without stent implantation and leave no implants behind. They have proven a promising strategy for in-stent restenosis when stents re-narrow due to scar tissue formation. Drug-coated balloons are also useful in tackling small vessel coronary artery disease and bifurcation lesions at artery branch points where a stent might cause blockages.

Rotablation and intra-vascular lithotripsy

Rotablation or rotational atherectomy is used to tackle very hardened areas of arterial disease, where calcium deposits make balloon inflation and stent placement impossible. A small diamond-tipped drill is introduced into the coronary artery. The drill spins at high speeds, causing the calcified material to be worn away. Tiny particles of material less than a thousandth of a millimetre are dispersed into the circulation. The treatment allows conventional balloon and stent treatments to be then completed.

Intravascular lithotripsy is another way to deal with calcification. This technology uses energy delivered by a low-pressure balloon to soften the artery. Tiny microfractures in the calcific tissue mean the artery can be more safely dilated to accommodate a stent.

Chronic total occlusions

Some coronary arteries may have been blocked for several months or even years. These blockages are especially hard to open using conventional coronary wires and balloons. Specialist approaches are needed, often with two entry points for arterial access. Use of niche technologies, including high-tip weight wires, dedicated micro-catheters and snares, may be needed. Usually, this type of procedure is reserved for patients who have refractory symptoms that do not respond to conventional drug treatments or where surgery is not an option

What is Percutaneous Valve Replacement and Repair?

Percutaneous valve replacement and repair are minimally invasive procedures for treating heart valve diseases. These procedures are performed through small incisions using catheters, offering an alternative to open-heart surgery. Transcatheter Aortic Valve Implantation (TAVI) and M-TEER are two common procedures.

 

What is TAVI?

Transcatheter Aortic Valve Implantation (TAVI), also known as Transcatheter Aortic Valve Replacement (TAVR), is a procedure used to replace a narrowed aortic valve that fails to open correctly (aortic stenosis).

 

What is percutaneous edge-to-edge mitral repair (TEER)?

TEER is a procedure used for ‘keyhole’ heart valve repair. Mitral TEER (M-TEER) treats mitral regurgitation (MR), where the mitral valve does not close properly, causing blood to flow backwards into the heart. This causes congestion of the lungs and breathlessness and may lead to swollen ankles and abdominal fluid buildup. Currently, two M-TEER technologies are available: the Mitra Clip and the Pascal devices, both of which are used in Manchester. 

 

Benefits of TAVI and M-TEER

Minimally invasive with shorter recovery time.

Reduced risk of complications compared to open-heart surgery.

Improved quality of life and symptom relief.

Suitable for high-risk patients who are unsuitable for open heart surgery.

 

The TAVI Procedure

A catheter is inserted through a blood vessel in the groin, guided to the heart, and positioned within the diseased aortic valve. A new valve, mounted on a balloon or in a self-expanding frame, is deployed to replace the diseased valve. The procedure is performed under local anaesthetic and takes around an hour. Sometimes, the heart rate can slow afterwards, and between 5 and 10 per cent of people may require a pacemaker.

 

The M-TEER Procedure

A catheter is inserted through a vein in the groin and guided to the heart.

The M-TEER device is positioned and attached to the mitral valve to reduce valve leakiness by bringing the valve leaflets closer together. This treatment requires general anaesthesia and takes up to three hours in complex cases. A trans-oesophageal echo is performed continuously to guide the operation.

Sometimes, cardiac surgery can offer the best long-term solution for coronary artery disease or heart valve disease. Dr Sarma works with excellent cardiac surgical colleagues from the North West of England. These surgeons have a wide range of specialist experience and have undertaken groundbreaking research, developing new innovative working methods. Many are leading national figures and participate in areas including heart and lung transplantation, aortic repair, coronary bypass surgery and valve replacements. Cardiac surgery remains an intrinsic part of cardiology treatment, and we are proud to work with some of the best surgeons in the country.