Second World War marine veteran Lucien 'Tod' Raven-Hill MBE – who fought at several major battles including the D-Day invasion of Normandy – had his aortic valve replaced using a new keyhole surgery technique.
Conventional valve replacement involves major open heart surgery but Mr Raven-Hill’s operation was performed through the skin, or “percutaneously”, using just one small incision.
The operation had become necessary, explains Royal Brompton consultant interventional cardiologist Dr Simon Davies, because of a narrowing of Mr Raven-Hill’s aortic valve.
“Mr Raven-Hill was suffering from a heart valve disease called aortic stenosis,” says Dr Davies, who is Tod’s cardiologist. “In this condition the aortic valve becomes stiff and narrowed. This narrowing means that the heart has to work harder to pump the same amount of blood. Eventually the heart cannot keep up, blood flow becomes reduced, and this leads to chest pain, shortness of breath, and fainting. In Mr Raven-Hill’s case the heart could not keep up in just this way.”
Minimally invasive heart surgery
“I had shortness of breath while exercising,” explains Tod, an 85 year old resident of Whitton in Richmond on Thames, London. “In the three months before the operation I fainted several times while walking too fast, getting up off a chair too quickly, or carrying heavy objects.”
It was in late 2006 that Mr Raven-Hill’s doctors decided that a valve replacement was necessary. But there was a concern: Tod had recently undergone surgery on his neck. During the operation, his right vocal cord had been damaged making it hard for him to talk and to cough.
“After open heart surgery it is important for the patient to be able to breathe deeply and cough effectively,” explains consultant cardiothoracic surgeon Mr Neil Moat. “This helps to clear the chest and prevent complications such as pneumonia."
Hope for high-risk aortic valve replacement patients
“As Mr Raven-Hill had some other medical problems and a markedly reduced ability to cough, we believed that he was at high risk for conventional aortic valve replacement.”
The solution proved to be percutaneous valve replacement, a new technique considerably less invasive than traditional surgery. Instead of making a large incision in the chest the Royal Brompton Hospital team were able to conduct the procedure making a small cut in the groin through which a plastic tube (catheter) is inserted into an artery.
The tube is then guided up towards the faulty valve. Once the tube is in place an artificial valve is passed along the catheter and expanded into position.
Keyhole surgery through a small incision
As the surgery involves only a very small incision, patients can recover more quickly than they would with conventional surgery. Tod was able to leave hospital just five days after his operation.
“I recovered very quickly from the operation,” he says. “I was able to walk around the wards on day two, first at a leisurely pace and then at a small trot with no adverse effects. On day three I went up and down four flights of the hospital stairs."
“I am gaining my strength back day by day and feel very well and fit.” Mr Moat explains that it is hoped many more patients will benefit from the new type of surgery although emphasises that it currently has limitations which mean it is only suitable for use in a few selected patients.
Alternative to invasive surgery
“We have a very good success rate with conventional surgery,” he says. “However, it is invasive and for some patients the risks outweigh the benefits. The keyhole technique is very useful for patients who are not candidates for conventional surgery or who are felt to be at very high risk from a conventional procedure.”
“Since Mr Raven-Hill’s successful procedure, the team has gone on to successfully treat another seven patients with severe aortic stenosis using this technique.”
Meanwhile Mr Raven-Hill says he is pleased to be a pioneer. “I am very proud of being the first patient at Royal Brompton to have this operation. I cannot speak highly enough of the thorough care and attention that I have received from Mr Moat, Dr Davies, the ward sisters, nurses, and the whole team.”
Mr Raven-Hill passed away peacefully on 27 January 2013, aged 90 years. He is survived by his widow Aileen, his son Paul, daughter-in-law Elizabeth, grand-daughters, Charlotte, Rebecca and Emily and great-granddaughter, Ella Jane. R.I.P.
We are grateful to Mr Raven-Hill's family for continuing to allow us to share his story.