Successful Unprecedented Heart Surgery Conducted by SUMS Physician

Dr. Ahmad Ali Amirghofran, SUMS Cardiac Surgeon, performed beating-heart tricuspid valve replacement grafting tissue of the patient’s heart for the first time in the world. The surgery was done at SUMS Shahid Faghihi Teaching Hospital on a 14-year-old patient, who is now continuing his convalescence at Nemazee Teaching Hospital.

As Dr. Amirghofran explained, valvular heart diseases are among the most common heart complaints. In these cases, the physician tries to repair the damaged valve, but if the function of a cardiac valve is severely impaired or the heart valve is too badly damaged to be repaired, valve replacement surgery will be necessary. The available valves used as a replacement are either made of metal or biological tissues from a human or animal. However, some significant challenges might be posed if such types of valves are used. On the one hand, a metal valve may increase the risk of thrombus, and the patient must take anticoagulants for life. On the other hand, valve damages or transplant rejection caused by the immune response of the host body and the need for another valve replacement surgery are highly probable in the cases of xenograft or homograft transplants, he added.

Dr. Amirghofran also stated that developing the aforementioned complications may happen faster for the recipients showing damages to the right-sided cardiac valves (aortic and tricuspid). Therefore, making a heart valve for valve replacement in the right side of the heart, which works for a longer period or a lifetime, has always been a dream in cardiac surgery. Discussing these points and referring to the formation of an idea to design a valve from patients' tissues that can replace the pulmonary valve, he said that about ten years ago, he had made a valve from a patient’s auricle of the right atrium, which was considered a redundant tissue. The patient’s pulmonary valve was replaced with the prepared valve, and then, to determine the long-term or medium-term effectiveness of this valve, after five years, the patient underwent angiography. Surprisingly, it was found out that the transplanted valve had been performing highly efficiently, he declared. Since 2017, this method has been widely applied across the globe. This method is now standardized to a great extent bringing satisfactory results for 140 patients in Iran.

According to Dr. Amirghofran, applying this method for tricuspid valve replacement surgery is a step beyond previous procedures. In this surgical method, the right-sided atrial valve is placed in the position of the tricuspid valve. Considering the greater complexity of the tricuspid valve compared to the pulmonary valve, the procedures of making a valve and its replacement demand a more complicated design. As he remarked, the tricuspid valve of this teenager was completely deteriorated due to infection; thus, he was an ideal case for receiving autograft valve tissue. Fortunately, the results of the surgery and post-surgery investigations indicated the successful outcome of the invented method. The echocardiograms done after the operation revealed the complete similarity of the replaced valve to a normal human heart valve. Besides, because the tissue was grafted from the patient, the probabilities of his immune system reaction and tissue rejection would be very low. Also, as the child grows up, the valve will grow, too.  Finally, Dr. Amirghofran expressed his hope that the tissue remains alive in the patient’s body for a lifetime; however, stating a definitive opinion and presenting long-term results need the passage of time, he concluded.  

Click here to watch the news video in Persian.