Highly specialised endovascular interventional techniques brought to Pietermaritburg hospital – Specialised minimally invasive coronary interventions completed at Netcare St Anne’s Hospital

Advanced minimally invasive catheter-based percutaneous coronary interventional (PCI) procedures have been brought to Netcare St Anne’s Hospital in Pietermaritzburg in an initiative that seeks to upskill local specialists.

A leading Gauteng-based cardiologist, Dr Chris Zambakides, acted as a proctor to oversee and assist local cardiovascular specialists to successfully perform two of these new highly intricate procedures at the catheterisation laboratory at the cardiovascular centre at Netcare St Anne’s Hospital recently.

Dr Kyi Shein, a cardiologist at Netcare St Anne’s Hospital who assisted in facilitating the initiative, says that the procedures were conducted as part of a training event for local cardiac specialists from both the state and public sectors in these highly advanced techniques.

These catheter-based procedures are undertaken through the tiny puncture in the skin and eliminate the need for major surgical incisions. According to Dr Shein, the two procedures included a rotational endarterectomy (rotablation), in which a tiny drill powered by compressed air and special fluid to clear the calcified deposits were used, and a percutaneous coronary intervention to chronic total occlusion (CTO) to re-canalise a chronically blocked portion of an artery.

“This training session, which proved most valuable to our local specialists, was made possible through a collaboration between Netcare St Anne’s Hospital and sponsorship by Boston Scientific, a US-based company which markets medical technology and equipment. We are also most grateful to Dr Zambakides who practises at Netcare Union Hospital in Alberton for making his time available to impart his knowledge and rare set of skills to local doctors.”

Dr Zambakides, who was trained extensively in complex catheterisation procedures abroad, explains that rotablation involves advancing an extremely small drill head to the site of the blockage in the blood vessel, using catheter wires through a puncture in the skin.

The calcified blockage in the blood vessel is drilled away and thereafter a balloon or stent is forwarded to the diseased site and inflated to ensure that the vessel remains open. Such procedures are increasingly being used around the world as an alternative to traditional open bypass surgery, he explains.

In the case involving the chronic totally occluded vessel, special micro-catheters, which have been developed in Japan, were used to successfully treat and re-canalise a lesion through tiny micro-channels. One micro-catheter was advanced forward into the artery while another was advanced through the opposite artery of the chronically occluded artery.

“There are still only a few cardiovascular specialists in South Africa and overseas who are familiar with treating chronic total occlusion. These are highly intricate procedures to perform and do take some training,” says Dr Zambakides.

“Programmes such as this are to be commended as they are seeking to impart the necessary skills to more specialists throughout our country. As proctors we are able to demonstrate the procedures and carefully guide interventional cardiovascular specialists through the operations so that they are able to get practical hands-on experience.”

Dr Zamabakides says that minimally invasive catheterisation procedures have become more popular in recent years as they are not as traumatic as traditional surgeries and patients tend to recover much quicker with a lower risk of complications.

“Ever more sophisticated technology is constantly being introduced and there is an ongoing improvement in techniques. It is important that we in South Africa are able to stay abreast of these developments.”

Netcare St Anne’s Hospital’s general manager, Louis Joubert, says that the facility, which made available its state-of-the-art catheterisation laboratory for the training event, is proud to have been afforded the opportunity to participate in an initiative to transfer knowledge and skills to local specialists.

“We are grateful to Dr Shein for his assistance in organising the event, which is important to the future of cardiovascular medicine in our city, as well to Dr Zambakides for making himself available to lead this educational programme,” adds Joubert.

“I would also like to thank the team at our cardiovascular centre for making this initiative possible. The centre is leading the way in this field of medicine in the Pietermaritzburg and the Midlands regions in ensuring that we provide the highest levels of care to our patients,” he concludes.