NUHCS training more surgeons on less invasive heart valve implant

TAVI targets a condition that often begins with a heart murmur.

The National University Heart Centre Singapore (NUHCS) is training the region’s specialists on a minimally invasive procedure to replace the aortic heart valve, which has been proven to be superior to open surgery for patients with an immediate risk of complications.

The centre targets cardiologists and surgeons from countries where the procedure — called transcatheter aortic valve implantation (TAVI) — is still in its early adoption phase, Ivandito Kuntjoro, a senior consultant cardiologist at NUHCS’s Department of Cardiology, told Healthcare Asia.

“The Philippines, Thailand, and Malaysia are doing TAVI,” he said via Zoom. “But [NUHCS] has been doing this for 10 years and has performed a high number of procedures.”

The demand for the procedure continues to rise, with the global market valued at $7.01b in 2024 and expected to grow 10.1% annually to $12.41b by 2030, according to a Next Move Strategy Consulting report.

Kuntjoro, who is the director of NUHCS’s Structural Heart Program, said the centre provides training that includes hands-on experience and the management of complex structural heart cases at clinics, hospitals, and intensive care unit settings.

They train one fellow a year and funding support comes from the hospital and, at times, from the trainee's home institution, he said.

NUHCS uses 3D simulation for the training. “Each patient undergoes a CT (computed tomography) scan, allowing us to generate a detailed 3D analysis of the access route and the aortic annulus geometry,” Kuntjoro said.

The procedure is done in patients with aortic stenosis, where one of the heart’s valves narrows, making it harder for blood to flow to the rest of the body. Symptoms include chest pain, breathlessness, or fainting episodes if left untreated.

“One key sign is a heart murmur,” he said.

“In Singapore, where the population is ageing, the condition’s incidence is notable,” the cardiologist said. “According to general estimates in other populations, the prevalence of aortic stenosis in people aged 65 and older can range from 2% to 7%.”

The centre allows trainees to observe live procedures. “The day before [the procedure], we hold didactic training, covering the procedure's indications, benefits, side effects, and other key information.”

"Our consultant also serves as a TAVI proctor, travelling across the region to train and supervise new centres or assist with complex procedures at established centres,” he added.

NUHCS uses artificial intelligence (AI) to help analyse ultrasound images for diagnosing heart problems. While the centre does not use AI for TAVI itself, doctors continue to adopt the latest tech, including the newest valve generations, he said.

Kuntjoro, who is a clinical assistant professor at the National University of Singapore’s Yong Loo Lin School of Medicine, urges early detection, particularly for aortic stenosis.

"When people think about heart issues, they often assume it’s all about heart attacks or high blood pressure, but valve problems are common too,” he said. “People need to recognise the symptoms, as delayed treatment can lead to permanent heart damage.”