The Ozaki procedure

Cesare Quarto, consultant cardiac surgeon at Royal Brompton and Harefield Hospitals Specialist Care, is an irrefutable expert when it comes to matters of the heart. He was appointed as a consultant at Royal Brompton Hospital in 2013 and two years later earned a trio of international awards for his role in a world-first transcatheter heart valve implantation (TMVI/TAVI).

More recently, in 2016, Mr Quarto led the Royal Brompton and Harefield Hospitals (RB&HH) team which carried out the first adult Ozaki procedure – a groundbreaking treatment for aortic valve disease, a life-threatening condition – in the UK. This cutting-edge technique, devised by Professor Shigeyuki Ozaki in Japan a decade ago, uses heart tissue from the patient or an animal to reconstruct a damaged aortic valve, instead of replacing it entirely with a prosthetic implant.

“This is an exciting development,” enthuses Mr Quarto. “Between 2007 and 2015, Professor Ozaki performed his procedure on 765 patients and over 98 per cent of them have not required any further aortic valve operations, which is impressive and very encouraging.

“Aortic value disease is common for those in their 70s, although sometimes we have patients in their 40s, 50s or 60s who have severe aortic valve stenosis or degradation. I think it is this younger group who can really benefit from the Ozaki procedure because they are unlikely to need repeat surgery.

“Our hope is that this procedure, using the Ozaki valve, will last longer than a normal aortic valve replacement and has a better haemodynamic, meaning that the blood flows better to the valve. If the valve can be repaired it should be, of course, but if not then this is a good option for reconstruction.

“The evidence shows it can be a longer-term solution than the other options due to its more natural physiology. We hope many of our patients will benefit from this novel technique in the future.”

Mr Quarto presented a “short business case” to the management team at RB&HH to “explain the Ozaki procedure and outline why it would be good for the hospital”. He continues: “They were very open to the idea, as I thought they would be; that positive attitude is the main difference between Royal Brompton and Harefield Hospitals and many of the other hospitals at which I have worked.

“I was asked what I required and I said, ‘I need to go to Japan to see the procedure and it is also important that Professor Ozaki comes here to London to support me.’ The management were happy with that and supported this happening.”

RB&HH is the UK’s only unit that is able to provide this treatment to adult patients, both privately and on the National Health Service. In addition, Mr Olivier Ghez, a leading paediatric cardiac surgeon at the hospital, who alongside Mr Quarto performed the first Ozaki procedure in the country, offers it to children and young adults as an alternative to valve replacement surgery.

It is the latest example of how innovation is at the beating heart of the Royal Brompton and Harefield Hospitals NHS Foundation Trust, which boasts the largest specialist cardiac and lung centres in Britain, and whose trailblazing consultants use the most sophisticated treatments available anywhere in the world.

“The sole reason I came to this country in 2007 was to work at Royal Brompton and Harefield Hospitals because I knew they had a brilliant vision for the future,” adds Mr Quarto. “For me, it is the number-one place in Europe. All my colleagues are very supportive of new ideas and it makes for a great, happy atmosphere. We work together to continually improve and raise the standard.

“Consultants who work at the Royal Brompton and Harefield Hospitals benefit from being exposed to outstanding innovation and having exceptional support from management. Peers and industry leaders from around the world often approach me to discuss innovative surgical techniques and products as our hospitals are known to be open to the latest cardiac technologies. So at the international level we are very well regarded. It’s a very competitive space, but we are leading the way.”

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