Edin Mackic with his family.

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 was 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.

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"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 comprising 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 anaesthesia, 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 centre 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 per cent 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 anaesthesia, 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 minimise contrast exposure before and during the TAVR procedure. We have worked closely with our cardiac imaging experts to minimise contrast exposure at every step of the preoperative evaluation.

Physicians at Cleveland Clinic Abu Dhabi have also achieved a low pacemaker rate in patients who 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.