Morriston's UK-leading team broadcasts real-time cardiac procedures to India

Heart specialists at Morriston Hospital are sharing their expertise internationally by broadcasting procedures on patients in real time.

Delegates at two conferences in India watched the angioplasties as they happened in the catheterisation labs at the hospital’s Cardiac Centre.

An angioplasty is a minimally invasive treatment for the narrowing of the heart arteries. It involves using a balloon and a stent, a thin metal tube, to restore the flow of blood.

Morriston is the largest angioplasty centre in Wales and its cardiac catheter laboratory is rated the most efficient in the UK.

And now, thanks to an educational grant that allowed it to invest in a new audiovisual system, it can not only broadcast around the world but create a library of training videos for current and future doctors – for free.

Consultant interventional cardiologist Dr Anirban Choudhury is the cath lab lead at Morriston Hospital.

“Of all the cardiac centres which report to the national database for cath lab efficiency, Morriston is rated the most efficient in the UK,” he said.

“We go through a lot of work within our footprint, which, if you benchmark it with similar activity at other centres around the UK, you probably find it would need five cath labs.

“So, the staff here work very hard and in a very efficient way to have the throughput that we have.”

The standard of work is recognised by companies which supply specialist equipment to the cath lab. One awarded an educational grant, which was used to install an audiovisual system in one of the cath labs.

Dr Choudhury was initially approached by organisers of the largest complex angioplasty conference, CHIP India, held in Chenai. They asked him if he would travel to India and do a live case there.

“I took the opportunity to ask, why don’t we do it from our centre? We did, and it was very well received,” he said.

“Then we had another invite, to the SCION conference in Kolkata, which was on a Saturday. I spoke to our staff, and they came in on their off day because we all enjoy showcasing the work that we do.

“It goes to show the camaraderie and the working together in the cath lab of the various professionals.

“Again, it worked really well. We were operating and could communicate directly with the panel and the chairperson in Chenai or Kolkata. They were asking questions and we were answering them.”

Left: How delegates in India saw the angioplasty procedure as it happened in real time.

Like all organs, the heart needs a constant supply of blood, which is supplied by the coronary arteries. These can become narrow and hardened, a condition known as atherosclerosis.

This can cause coronary heart disease. If the flow to the heart becomes restricted it can cause angina – chest pain. An angioplasty is also used as an emergency treatment following a heart attack.

An angioplasty is carried out under local anaesthetic and, for eligible patients, is an alternative to the far more invasive open-heart surgery.

It involves inserting a thin, flexible tube called a catheter into the one of the cardiac arteries through an incision in the groin, wrist or arm.

Once this in place, a thin wire with a balloon on the end is guided to the affected section of the artery. It is inflated to widen the artery, restoring blood flow.

Sometimes a stent, a wire mesh tube, is inserted along with the balloon, remaining in place while the balloon is deflated and withdrawn.

However, the two conferences focused on complex angioplasty. And the live broadcasts from the Morriston cath labs also involved an additional procedure called orbital atherectomy.

“This involves a drill which we use when the narrowing of the arteries is extremely calcified so balloons cannot inflate,” said Dr Choudhury.

“It is a piece of technology that came to the UK in 2022 and we happen to have the largest experience in the whole of the UK.

 “We put the drill up through the artery and it breaks down the calcium and then it prepares the narrowing, which is then compliant for the balloons and stents to go up efficiently.”

Dr Choudhury said the audiovisual equipment meant it was possible to create a suite of training videos, covering different techniques, which could be used for education purposes.

Last year, Morriston carried out 1,750 angioplasty procedures and, said Dr Choudhury, had built up a reputation for excellence.

This reputation, he said, went some way towards helping with staff recruitment and retention at a time when other centres were struggling.

“But what really helps is we have a very happy cath lab team. We have professionals who are respected for their roles,” he added.

“The biggest reason why we have a very good retention rate among cath lab staff is the environment and how they feel and how they are valued.”