69-YEAR OLD HEART FAILURE PATIENT ‘FEELS YOUNGER’ AFTER SURGERY

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69-year-old patient underwent the latest technology valve replacement surgery that had him return to daily life the next day

Abu Dhabi, United Arab Emirates: Abu Dhabi resident Edin Mackic believes that he now has something in common with Hollywood actor Arnold Schwarzenegger. In October 2020, while the 69-year-old patient of Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, was undergoing a minimally invasive transcatheter aortic valve replacement (TAVR) in the capital, he read media reports of the 73-year-old star having the same operation miles away in the US.

“It was exciting to read that we were going through the same experience. I’m from Bosnia and he is from Austria and I’ve seen a lot of his movies, and after this valve replacement operation at Cleveland Clinic Abu Dhabi, I can say that I feel as strong as he looks in them,” says film fan Edin.

Edin presented to the hospital with heart failure symptoms, including shortness of breath and chest pain. What he did not know was that he had been suffering from severe aortic stenosis, caused by a calcific and degenerative valve disease. This serious valve problem restricts the blood flow from the left ventricle to the aorta but may not cause noticeable symptoms immediately. 

“I’ve always been healthy with not many complaints except for high blood pressure and the occasional spike in my blood sugar levels. But I’ve usually put a lot of my health concerns down to age. In October, I felt like someone was stabbing me in the back with a knife. I was afraid and decided to see a doctor.”

Dr. Ahmad Edris, a Staff Physician in the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi, who is part of Edin’s multidisciplinary care team, says his case should serve as an important lesson for people to get examined for heart issues regularly.

“A lot of older people ignore symptoms because they think shortness of breath and reduced physical activity is part of growing old. But a significant number also have valve disease and regular screening can help identify problems like heart murmurs early on, which helps improve the outcomes for these patients,” he says.

“At the same time, physicians caring for the elderly shouldn’t feel like they are out of options to treat them because they think open heart surgery can be risky for the frail. In fact, most of our patients undergoing TAVR are above the age of 75 years, and almost all are discharged the next day with swift recovery.”

In TAVR, the valve is replaced using catheter-based technology through a small opening in the leg artery. The minimally invasive TAVR can be performed in appropriately selected low-risk patients.

“The decision to perform TAVR is made after careful consideration of the patient’s medical history by an experienced multidisciplinary team comprised of both cardiac surgeons and cardiovascular medicine consultants. With Edin, we discovered clinical features, including severe disease involving the arteries leading to his brain that placed him at high risk for stroke with traditional open-heart surgery,” says Dr. Edris.

The TAVR team was able to replace his valve with the latest fourth generation TAVR technology using conscious sedation rather than general anesthesia, which further reduces the risk of complication and improves recovery, while avoiding side effects of typical open-heart surgery.

Cleveland Clinic Abu Dhabi is the highest volume TAVR center in the country with all patients included in a registry to evaluate and report outcomes.

“We use a minimalist approach for this procedure and have implemented the same best-practices as Cleveland Clinic Foundation in the United States. This has allowed us to achieve excellent and comparable outcomes. It takes about 45 minutes to perform the procedure and 90 percent of our patients are discharged the next day,” says Dr. Edris.

Dr. Edris explains that a minimalist approach means using minimal sedation rather than general anesthesia, avoiding most of the invasive catheters used in open heart surgery, and avoiding more invasive ultrasound or echocardiogram imaging guidance and using imaging through the chest wall instead.

“A significant portion of our patients have chronic kidney disease. So, we have adopted several measures to minimize contrast exposure before and during the TAVR procedure. We have worked closely with our cardiac imaging experts to minimize contrast exposure at every step of the preoperative evaluation.

Physicians at Cleveland Clinic Abu Dhabi have also achieved a low pacemaker rate in patients that have undergone this surgery.

“We have achieved this by our implantation technique to avoid the electrical system of the heart. This means that we have only had to implant a permanent pacemaker in a single patient in the last two years,” says Dr. Edris.

Edin says that the surgery has given him a new life. “No words can express how thankful I am for the care I received at Cleveland Clinic Abu Dhabi. I feel younger now and have been out and about since leaving the hospital. My message to people is that it is important to see your doctor, especially as you get older so that you can live a longer and healthier life. If I have any health problems now, my doctors know that, like Arnold, I’ll be back.”

About Cleveland Clinic Abu Dhabi:

Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, is a multispecialty hospital on Al Maryah Island in Abu Dhabi, UAE. Cleveland Clinic Abu Dhabi is a unique and unparalleled extension of US-based Cleveland Clinic’s model of care, specifically designed to address a range of complex and critical care requirements unique to the Abu Dhabi population.

Cleveland Clinic Abu Dhabi has the following Institutes: Heart & Vascular, Neurological, Digestive Disease, Eye, Respiratory, Critical Care, Surgical Subspecialties, Medical Subspecialties, Emergency Medicine, Anesthesiology, Pathology & Laboratory Medicine, Imaging, Quality & Patient Safety, and Clinical & Nursing. In all, more than 40 medical and surgical specialties are represented at Cleveland Clinic Abu Dhabi.

The facilities at Cleveland Clinic Abu Dhabi combine state-of-the-art amenities and world-class service standards. The hospital is a 394 (expandable to 490) bed facility, with five clinical floors, three diagnostic and treatment levels, and 13 floors of critical and acute inpatient units. It is a physician-led medical facility served by North American/European Board Certified (or equivalent) physicians. Cleveland Clinic Abu Dhabi provides patients in the region direct access to the world’s best healthcare providers and Cleveland Clinic’s unique model of care, reducing their need to travel abroad for treatment.

Cleveland Clinic Abu Dhabi – Al Ain began offering select medical services in December 2017. The facility is located on the Tawam Hospital Campus in Al Ain.

About Mubadala Health:

Mubadala Health is the integrated healthcare network of Mubadala Investment Company. Established 2021, Mubadala Health operates, manages, and develops a portfolio of healthcare assets including: Abu Dhabi Telemedicine Centre (ADTC), Amana Healthcare, Capital Health Screening Centre (CHSC), Healthpoint, Imperial College London Diabetes Centre (ICLDC), and National Reference Laboratory (NRL).

With a vision to transform the regional healthcare landscape, Mubadala Health sets a new benchmark for the UAE and regional healthcare industry through its state-of-the-art facilities and world-class caregivers who strive to put patients first across its continuum of care. Innovation, research, and education are the foundational pillars of Mubadala Health, supporting the further development of a sustainable healthcare sector in line with the vision of Abu Dhabi and the region.