New, less invasive procedure used in Singapore to solve blockage in mechanical heart pump

By Zachary Lim

3/28/2025 10:41:00 AM | The Straits Times

The article is contributed/written by

The minimally invasive treatment for a mechanical heart pump's outflow graft obstruction will minimise risks of infection and shorten inpatient care to just a few days. ST PHOTO: GIN TAY

When 42-year-old logistics supervisor Rizal Mohamed Ismail’s mechanical heart pump alerted him frequently about a potential blockage in the device, he was worried that he had to undergo another open-heart operation.

“I first got my implant on March 10, 2022, and my surgery took somewhere between eight and 12 hours. I was then (hospitalised) until April 8, 2022,” he said.

Instead, his doctors offered him a novel, minimally invasive option to solve the problem that saw him discharged just four days after the treatment.

“The procedure was very fast, and I recovered really quickly. I have the doctors to thank for that,” he said.

Mr Rizal is only the second patient in Singapore to receive this treatment, which was presented to the media on March 27.

The treatment was carried out in September 2024 at the National Heart Centre Singapore (NHCS), which treats cases of blockages in mechanical heart pumps known as left ventricular assist devices (LVADs).

The LVAD is attached to the left ventricle of the heart and pumps oxygenated blood into the aorta, which distributes it to the rest of the body through branches of smaller vessels.

Material known as bio-debris can build up in the device’s dual-layered tubing, known as the outflow graft, creating blockages that compress the inner tube and restrict blood flow. This may ultimately cause the pump to malfunction.

(From left) NHCS Department of Cardiothoracic Surgery consultant Zameer Abdul Aziz, principal clinical coordinator Jael Tay Hwee Ming, logistics supervisor Rizal Mohamed Ismail, and NHCS Department of Cardiology senior consultant Jonathan Yap at the National Heart Centre Singapore on March 27.ST PHOTO: GIN TAY

Before the new treatment, doctors would solve the blockage problem by creating an incision over the graft before removing the debris manually. Recovery time for this older procedure is about 10 days.

The new procedure, which takes about two hours to complete, creates an incision on the leg. It involves multiple experts, including transplant surgeons, cardiac interventionists, echocardiologists and an interventional radiologist from Singapore General Hospital.

A wire with a 14mm-long balloon attached to its tip is inserted into a patient’s femoral artery through a small skin incision on the leg, before sending the balloon to the graft.

The balloon is then inflated with liquid to expand the graft, pushing the accumulated debris, which is made up of protein deposits, against the wall to allow for a wider channel for blood flow.

The balloon is then removed and replaced with a metal stent, which keeps the graft open. In the process, some of the protein deposits may get dislodged and be flushed away into the bloodstream, and later broken down by the body.

“We want to minimise repeat surgical procedures in our patients... If they’re going for a repeat open-heart surgery, we want to reserve that for when they get a transplant,” said Assistant Professor Zameer Abdul Aziz, a consultant at the Department of Cardiothoracic Surgery at NHCS, who led Mr Rizal’s surgery.

The procedure was introduced to eliminate the need for major operations, which may introduce infections and have a long recovery period, NHCS noted.

After Mr Rizal, a third patient has since successfully received the new minimally invasive percutaneous – or through the skin – treatment, and it is now available for all patients with LVADs, added NHCS.

Associate Professor Jonathan Yap, a senior consultant at the Department of Cardiology and director of structural heart interventions at NHCS, said: “While balloon and stent techniques are well-established for treating blocked blood vessels, applying this approach to mechanical heart pumps marks a significant breakthrough.”

Though the new procedure has been adopted in many healthcare systems around the world, it is still relatively new and only began surfacing in medical journals in the last two years, according to Prof Zameer.

So far, there have been no reports of blockage recurrence following the procedure, he added.

Mr Rizal is the second patient in Singapore to undergo the new percutaneous procedure, which is minimally invasive. ST PHOTO: GIN TAY

The number of patients with end-stage heart failure in Singapore continues to rise, with the heart transplant wait list growing each year. There are patients on the list who have been waiting for up to nine years for a suitable donor, according to Ms Jael Tay, principal clinical coordinator of mechanical circulatory support at the heart and lung transplant unit at NHCS.

Ms Tay, Prof Zameer and Prof Yap were all involved in Mr Rizal’s treatment.

To date, NHCS has done 152 LVAD implants, with 51 of them still receiving support from it, and some relying on it as a permanent solution.

Getting the LVAD implanted on his heart has changed Mr Rizal’s life – he had to give up his favourite hobby of swimming and can now hold only desk-bound jobs.

But he is grateful to have “a second life with the LVAD”.

“I knew I had to fight for my life and stay positive, especially for my three children,” he said.

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New, less invasive procedure used in Singapore to solve blockage in mechanical heart pump

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