A team at Macquarie University Hospital on Tuesday successfully performed the first Australian procedure to implant a coronary sinus reducer (CSR) in the heart of a patient with severe angina for whom no other treatment options remained.
The patient, 77-year-old Donald Stichter, has extensive coronary artery disease and had continued to suffer disabling chest pain and shortness of breath after exhausting all standard medical and surgical treatment options.
“For patients like Mr Stichter who’ve been told nothing more can be done, the CSR represents a genuine opportunity for renewed mobility and quality of life,” says interventional cardiologist Professor Martin Ng, who led the Macquarie team.
“This latest success represents another innovative achievement by our flagship structural heart program,” said Walter Kmet, CEO of Macquarie University Health.
“We’re proud to be a leader in interventional cardiology in Australia, offering procedures that change the lives of patients like Mr Stichter.”
(l-r) Interventional cardiologist Professor Martin Ng with patient Donald Stichter
The Shockwave Reducer* is a small, hourglass-shaped, stainless steel mesh device that is placed in the main vein collecting blood from the heart (the coronary sinus) via a catheter inserted in the groin or the neck.
By narrowing and thus increasing the pressure in the coronary sinus vein, the CSR is thought to redistribute blood flow within the wall of the heart, improving oxygen supply in the parts of the heart muscle where it is needed most.
Angina – chest pain caused by reduced blood supply to the heart muscle – is one of the most common symptoms of coronary heart disease.
For most people, a combination of medication and minimally invasive procedures such as angioplasty and placing stents in narrowed coronary arteries or coronary artery bypass surgery is able to restore blood flow to the heart and relieve symptoms.
However, a significant group of patients – thought to number many tens of thousands in Australia – continue to experience disabling chest pain for which medications no longer provide relief (so-called ‘refractory angina’), despite having undergone all stent procedure options or bypass surgery.
Many patients with refractory angina experience pain during even light physical activity, make frequent visits to emergency departments, and face ongoing anxiety, disruption and severely reduced quality of life.
“These patients can feel like their lives are ‘on hold’ – painful, unpredictable and very restricted with no viable treatments – so the CSR represents a potential new pathway to relief,” says Professor Ng.
“The procedure to implant the CSR is minimally invasive – it doesn’t require any open-heart surgery – and it usually takes less than half an hour, so most patients go home on the same day or the next day.”
Scientific evidence supporting use of the CSR has grown rapidly in recent years and the device has been tested in several high-quality randomised clinical studies, says Professor Ng.
Key studies have shown that CSR significantly reduces the frequency and severity of angina, reduces hospital presentations for chest pain, enhances patients’ exercise capacity and improves quality-of-life scores.
Importantly, implantation of the CSR device has been shown to be relatively safe, with a very low rate of complications in this high-risk group of patients.
“The CSR is backed by good clinical evidence, recognised in international guidelines, and increasingly used in major cardiac centres around the world,” says Professor Ng.
“It represents a potential breakthrough treatment for patients with intractable symptoms from coronary heart disease.
“We look forward to being able to offer it to more Australian patients living with refractory angina.”
*The Shockwave Reducer is manufactured by Shockwave Medical, a part of Johnson & Johnson MedTech. The Shockwave Reducer is not currently approved by the Therapeutic Goods Administration in Australia; its current use in Australia is on a case-by-case compassionate basis.
Professor Martin Ng and patient Mr Donald Stichter are available for further comment and interview by arrangement. Please contact Stephen Downes on 0412 962 429