Jan 20, 2021

Ninety-six-year-old Israeli Annette Caron was regarded by doctors in a number of the country’s hospitals as “too old” to undergo open-heart surgery to repair a blockage in her heart’s coronary artery. Her condition endangered her life and made it difficult for her to function. 

But Jerusalem’s Shaare Zedek Medical Center, known to many of the capital’s residents as “the hospital with a heart,” was ready to try something new to save her. For the first time in the world. A catheterization using a knife inserted into her heart was performed to treat her problem. “I got to a point where things I could do in the past became more and more difficult,” Caron recalled. “I consulted several doctors in the country, but all had the same answer – ‘It is better leave it alone and avoid additional harm,’ ” 

The operation was performed using a new Israeli development, a tiny knife a few millimeters in size that is inserted into the catheter and allows surgery to be performed through the catheter without stopping the pumping of the heart. The knife was developed by Shaare Zedek’s heart specialists, led by Dr. Danny Dvir, director of the hospital’s cardiac catheterization department, who specializes in unique catheterization techniques together with the Israeli heart-valve-repair company Pi-Cardia Ltd.

The company, a global leader in the development of non-implant, catheter-based solutions for treating heart valves, developed the ShortCut device to split the leaflets of a pre-existing valve to enable safe transcatheter aortic valve replacement (TAVR) in patients at risk for coronary obstruction or compromised coronary access.

The TAVR market, currently estimated at $5 billion, is predicted to double over the next five years, with the expansion into low-risk younger patients. However, this growth may be hindered by a fundamental challenge – During TAVR implantation, the leaflets of the pre-existing valve are pushed sideways, in a way which may compromise future coronary access in many patients. This, according to the company, can turn into a life-threatening complication of complete coronary obstruction in a significant number of patients who undergo a second valve implantation when their previous bio-prosthetic valve degenerates. ShortCut may be used in both situations to split the pre-existing valve leaflets to enable future coronary intervention and prevent coronary obstruction.

In catheterization for a heart valve transplant, explained Dvir, the valve ‘lealets’ are pushed aside by the new valve. In patients where the coronary arteries are right next to the valve, this can block the flow to the heart and cause a dangerous heart attack.

“We had to think about how to cut the leaflet that could cause a complication. We developed a small folding knife a few millimeters in size that can be inserted into the heart through the blood vessels and perform the surgery with the utmost care,” he continued. “The new development joins a range of unique solutions in the field of cardiac catheterization and promotes it to an era in which all possibilities are open.”

The patient was discharged and sent home within 48 hours of the end of the surgery and will be able to return to full activity soon. “The world of medicine has evolved so much in recent years,” exclaimed Caron, who worked as a nurse when she was in her 30s. “Then, medicine was very basic. Today it is possible to perform complex operations without cutting. It’s amazing! Thanks to this innovative treatment, I will be able to do thinks I used to do, like swimming and light walking. I miss spending time with my children and grandchildren. Now I call on everyone to go out and get vaccinated. I feel wonderful. I have already been vaccinated and I invite everyone to do so to get back to normal.”