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2008
NHC successfully re-accredited by JCI
NHC underwent the rigorous Joint Commission International (JCI) re-accreditation audit from 21 - 23 July 2008. The re-accreditation survey using the tracer methodology, included new standards and required a track record of 12 months. NHC drew nods of approvals from the auditors with its excellent score. The successful re-accreditation holds testament to the Centre’s commitment to develop and promote a safe and high quality environment for its patients and staff.
NHC's Stem Cell Research Achieves Revolutionary Breakthrough
Picture of the heart muscle-like cells (developed from stem cells) which appear to integrate into the recipient animal's heart muscle as seen in microscopic studies.
NHC’s stem cell research made headline news on 1 September 2008 when its researchers announced an important breakthrough in their research.
Animal studies have revealed that heart muscle-like cells generated from an adult’s own stem cells using a NHC’s patented method, have contributed to increasing the pumping force (or ejection fraction in medical term) of the heart by 3 - 5 per cent. This marks a significant improvement in the quality of life as it could mean that a previously bedridden patient with severe heart failure may improve enough to allow him to walk around a little.
The study, the first in the world, shows that human adult stem cells that are converted into heart-like cells before transplant are better than transplanting whole stem cells directly, which is the most widely used form of cell therapy for heart failure today.
Read more in our Newsroom.
Definitive Diagnostic Information with the Use of Improved Technology - Live 3D Transoesophageal Echocardiography
| The Philips Live 3D Transoesophageal Echocardiography (TOE) made its debut in the region at the 17th Singapore LIVE on 8 March 2008. This technology delivers exceptional image quality and accurately depicts the cardiac structure, pathology and functions. It enables on-the-spot evaluation, providing clinicians with more information for diagnostic and decision-making steps. |
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Patients especially those with heart failure, valvular disease such as rheumatic mitral stenosis and mitral valve prolapse and congenital heart disease are able to benefit from this technology.
For heart failure patients, it is essential that the left ventricular size, shape and function of the heart can be accurately quantified. This technology is not only able to make this analysis, it can also assess the suitability of patients for advanced heart failure therapy such as resynchronisation therapy.
For patients with valvular disease, surgeons and anaesthesiologists are now able to see the complete mitral valve from multiple perspectives while it is functioning with Live 3D TOE. Live images enable assessment of valvular function which previously was not available once the surgery starts. During the surgery, anaesthesiologists can easily monitor patients, perform analysis for surgeons, and assess procedure outcomes. Repairs can be made immediately before completing the procedure when needed.
For patients with congenital heart disease and require interventional procedure such as device implantation and closing of heart defects, the Live 3D TOE provides interventional cardiologists with more information as well as improved visualisation during the guided procedures.
‘We believe this improved technology will allow the clinicians to have a more definitive pre-surgical assessment, enabling them to show the patients the results of their tests in an easily understood manner and plan better for the treatment,’ said Dr Ding Zee Pin, Senior Consultant and Director, Echocardiography, National Heart Centre Singapore.
2007
Clinical Outcomes Comparable to International Standards
The Ministry of Health Information Paper on Heart Surgeries at Singapore Public Hospitals 2001 – 2005 revealed that NHC's clinical outcomes for heart surgeries are comparable to that of international standards. The Centre performed a total of 3864 heart surgeries from 2001 – 2005 with an observed mortality rate of 2.6%, well below the predicted mortality rate of 5.1%.
Click here to read more.
Reduced Radiation Dose For Patients Undergoing Multi-slice Computed Tomography (MSCT) Investigations
Patients now undergoing MSCT at the National Heart Centre (NHC) Singapore are exposed to a markedly reduced radiation dose by up to 60% with minimal or no reduction in image and diagnostic quality.
The reduction in radiation dose is achieved through the adoption of a prospective scanning software called ‘Helical Prospective Scanning’ which uses a specialised computer algorithm to predict when the heart is at rest and only turn on the X-ray tube at these particular times. Without the software, the X-ray tube of the scanner is switched on during the entire time when the patient is having a scan.
NHC carries out 400-500 MSCT in a year. An audit was conducted at NHC from November 2007 – January 2008 on a group of 108 patients listed for the CCTA. The audit findings revealed that this new technique resulted in about an average of 6.3mSv of radiation exposure to patients compared to 13.6mSv in the past. In fact, the lowest radiation scan performed at NHC achieved only 2.5mSv worth of radiation. This is particularly important to the patients’ safety since MSCT is increasingly used as a diagnostic tool for coronary artery disease.
First aorto-apical conduit, an unconventional heart procedure, done in Singapore
The National Heart Centre Singapore performed the first case of aorto-apical conduit in Singapore on a 40-year-old in April 2007.
The patient had had previous radiation therapy to his chest for lymphoma, and presented with heart failure from severe aortic stenosis. The operation could not be technically done in a conventional manner without severe complications, and hence a rare procedure, called the aorto-apical conduit was performed. What this does is to create a valved connection between the apex of the heart to the descending aorta hence allowing a new channel for blood to exit the heart, albeit in an unconventional manner.
The diseased valve is not excised, and is left alone.
This procedure avoids a sternomy, does not require full heart lung machine support, and potentially avoids all complications inherent in the conventional approach. This is the first operation done in NHC, and possibly in Singapore.
Patient's improvement was dramatic with an increase of his LVEF (left ventricular ejection fraction) from 15% to 40% immediately after surgery, and he has substantially improved his effort tolerance from less than 1 blocks to 4 blocks.
Patient recovered well and went home after six days.
This procedure provides a ray of hope for those who cannot have conventional surgery. Even worldwide, the procedure is very rare.
First Heart Centre in Southeast Asia with ViTALConnectÒ
- Remote access to Cardiac Tomography (CT) reports and manipulate realtime CT data in virtually any part of the world
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SCAN CVI (SingHealth Centre for Advanced Non-Invasive Cardiovascular Imaging) @ NHC is proud to launch the 64-slice Toshiba Aquilion Multidetector Computed Tomography (CT), which features ViTALConnectÒ, a first in Southeast Asia outside Japan, at its facility.
ViTALConnectÒ, is a web-based diagnostic tool that allows access and analysis of clinical images at multiple locations. This means that the clinicians can access not only CT reports but |
manipulate realtime CT data from a remote location with just a standard laptop computer and a secured internet connection. This greatly improves the workflow efficiency as it cuts down the need for doctors to travel between hospitals and departments.
The 64-slice Toshiba Aquilion Multidetector CT is also the first 64-slice CT system with 350ms rotation in Southeast Asia, providing better temporal resolution (12.5% faster than other sites).
The other advantages of the Toshiba Aquilion64 includes:
- Quantam detector design delivers 64 simultaneous acquired 0.5mm thin slices. This translates to improved clarity and resolution of scanned images.
- 64-slice data acquisition in cardiac scans; this implies that the entire heart can be covered in a few heartbeats.
- 3D-CTA of the arterial vascular system without venous contamination is assured.
- Provides up to 40msec temporal resolution. This translates into faster scan speed, clearer and more accurate images.
- The 1.8m scannable range accommodates scanning of trauma patients without the need to reposition.
- The sure Technologies are specifically designed to provide the best image quality at the lowest possible x-ray dose.
First in Southeast Asia to work on clinical validation and training for latest innovations
On 18 January 2007, National Heart Centre (NHC) Singapore and Philips Medical Systems signeda Memorandum of Understanding (MOU), making NHC the first in Southeast Asia to work with Philips in a clinical and educational collaboration involving the latest medical imaging technology.
With the installation of the state-of-the-art Philips Allura Xper FD10/10, NHC will be the first cardiac care facility to offer patients x-ray radiation that is significantly reduced compared to other conventional systems. The Philips Allura Xper also offers more accurate cardiac diagnosis with the availability of clearer imaging technology for stents in arteries and better visualisation of complex coronary arteries using an innovative 3D technique.
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This is also the first time that Philips Medical Systems is working with a reputed medical institution in Singapore in the cardiac laboratory imaging area. The collaboration will involve two parts - clinical validation of new innovative technologies on the Philips Allura Xper and training on the usage of the equipment for cardiologists from around region. |
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2006
Initiated the Robot Assisted Minimally Invasive Cardiothoracic Surgery (RAMICS) Programme
NHC Department of Cardiothoracic Surgery initiated the Robot Assisted Minimally Invasive Cardiac Surgery (RAMICS) Programme and performed our first case in December 2006. This followed our earlier success of the first robotic thoracic tumour excision in August 2005 using the Da Vinci system.
Our surgeons performed a CABG on a 44-year-old male with single vessel disease. The Da Vinci Robot was used to harvest the Left Internal Mammary Artery (LIMA) and LIMA to Left Anterior Ascending (LAD) was performed off pump via a small anterior thoracotomy. The patient did well and was discharged on the 4th post-operative day.
Record number of 14 patients supported on Extra Corporeal Membrane Oxygenation
2006 saw a record number of 14 patients on Extra Corporeal Membrane Oxygenation, the highest in a year since the inception of the mechanical heart assist device programme. Four patients were put on ECMO in their referring hospitals by our team of doctors, and were subsequently transferred over to NHC for further management.
First Centre in Asia to perform pulmonary vein isolation /Maze procedure using the EPICOR Cardiac Ablation system
The National Heart Centre Singapore became the first centre in Asia to perform pulmonary vein isolation / Maze procedure using the EPICOR Cardiac Ablation system which uses High Intensity Focused Ultrasound (HIFU) as an energy source for creating lesions to isolate the pulmonary veins. This procedure will simplify the treatment of atrial fibrillation as it can be performed without stopping the heart or going on cardiopulmonary bypass.
2005
First Heart Hospital Outside USA and in Asia to be JCI-accredited
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The National Heart Centre Singapore became the first heart hospital outside USA and in Asia to receive the prestigious Joint Commission International (JCI) accreditation in October 2005.
JCI is an extension of Joint Commission for the Accreditation of Healthcare Organisations (JCAHO). JCAHO is a body that accredits more than 90% of healthcare organisations in the United States. JCI accreditation standards are based on international consensus standards and set uniform, achievable expectations for structures, processes and outcomes for hospitals. They have accredited more than 70 healthcare organisations all over the world, and the list is growing fast. |
Getting JCI accreditation is part of NHC's commitment to improve the way we deliver healthcare. JCI's standards for hospitals clearly define the principles and processes needed to assess the key functions of acute care organisations and associated ambulatory settings.
First Robotic-Assisted Excision of Mediastinal Tumour
NHC Department of Cardiothoracic Surgery has successfully performed its first robotic-assisted excision of mediastinal mass. The operation on an 18-year-old male patient on 5 Aug 2005, used the Da Vinci surgical system and was facilitated by the Singapore General Hospital. Thoracic surgery using robotic technology has several advantages over one using standard endoscopic tools. The new technology offers all the potential benefits of a minimally invasive procedure. It provides better and more precise 3-D visualisation for the surgeon. The procedure also improves the quality of care because the patient experiences less pain after the surgery, hence recovers faster and spends less time in a hospital.
1999-2004
Surgical Treatments for Ischaemic Heart (STICH) Failure Trial
Heart failure is a chronic illness that is reaching epidemic proportions worldwide. STICH is a clinical research trial sponsored by the National Institutes of Health in the United States. It aims to determine what treatments will help patients with heart failure and coronary artery disease live longer. The STICH trial will include approximately 2,800 patients at 90 leading centres around the world.
The three treatments being compared in the STICH trial are:
1. Medical therapy alone
2. Medical therapy with coronary artery bypass graft surgery
3. Medical therapy with coronary artery bypass graft surgery and surgical ventricular restoration (surgical remodelling the shape of the left ventricle)
Depending on the degree of heart failure and coronary artery disease, patients are assigned to one of the three groups, each using a different combination of the treatments.
The Department of Cardiothoracic Surgery at the NHC is participating in this landmark study. To date, 15 patients from the NHC have been enrolled. NHC is the leading contributor to this study in Asia.
When completed, the results of this study will help determine if it is better to treat patients for heart failure and coronary artery disease with medical therapy alone or medical therapy combined with surgical procedures. In addition, this study will clarify the indications for surgical ventricular restoration.
Adult Congenital Heart Disease (ACHD) Programme
Initially started in 2003 with a weekly outpatient clinic, this programme has gone into full swing since April 2005, after the return of Dr Tan Ju Le from her training at Royal Brompton Hospital, London. The ACHD programme now offers:
- A weekly clinic offering care and follow-up of ACHD patients, screening of suspected Marfan patients, close monitoring of ACHD patients during pregnancy.
- A monthly Transistion Clinic in KK Women's and Children's Hospital run jointly with the paediatric cardiologists for patients above 16 years old. The aim is to give paediatric patients a smooth transistion from paediatric cardiology to adult cardiology services.
- Dedicated weekly congenital echo sessions.
- Dedicated weekly congenital cardiac catheterisation and intervention (particularly Atrial Septal Defect and Patent Foramen Ovale device closure).
- Dedicated ACHD nurse for education, support and care of ACHD.
- Surgical interventions including extra-cardiac Fontan procedures for uni-ventricular hearts, pulmonary homograft replacements for Tetralogy of Fallot patients with severe pulmonary regurgitation, Rastalli conduit for patients with pulmonary atresia.
- Expertise in Magnetic Resonance Imaging and multislice CT imaging for patients with congenital heart disease.
Indonesian Maid Becomes First Patient in Singapore To Fully Recover From Acute Fulminant Myocarditis with Support of ECMO Machine
27-year-old Indonesian maid made medical history in April 2004 when she became the only patient with acute fulminant myocarditis to be placed on the Extra-Corporeal Membrane Oxygenation (ECMO) machine for 14 days, which is the longest in Singapore.
The domestic worker, who was suffering from profound heart failure when she was admitted to National Heart Centre, was placed on the ECMO machine to allow her heart function to recover. She made dramatic recovery and her heart has since returned to 80% of its original function, making her the first person in Singapore to fully recover from this condition.
Revolutionary DOR Surgery With Dramatic Results
Heart failure patients are offered a new lease of life with a groundbreaking surgical technique performed by National Heart Centre doctors. Known as the DOR surgery, it involves the exclusion of damaged heart muscle and the reshaping of the heart from a conical shape back to its original spherical shape.
Done at National Heart Centre since 2002, the DOR procedure has so far been performed on eight patients with all patients being discharged after an average length of stay of 10 – 14 days.
In addition, patients who underwent this surgery had an 85% chance of not being re-admitted to hospital for recurrent heart failure within 18 months after surgery, and better survival rates.
Crossing The 15,000 Mark and The Journey Begins
The National Heart Centre’s Department of Cardiothoracic Surgery passed yet another milestone, crossing in March 2002 the 15,000 mark in its number of cardiac surgeries. The 15,000th patient was a 62 year-old female with stable angina.
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The Only Heart and Lung Transplant Centre in Singapore
National Heart Centre is the first and only local institution to have the heart transplant programme. The first heart transplantation in Singapore was carried out in National Heart Centre in 1990. Today, a total of 24 heart transplantation procedures have been performed. The survival rates of our heart transplantation patients are comparable to international standards of other established institutions.
In collaboration with the Department of Respiratory Medicine of the Singapore General Hospital, National Heart Centre has started the lung transplantation programme in 1999. The programme offers new hope for suitable patients with end-stage lung disease. Singapore’s first lung transplantation was performed on a patient with idiopathic pulmonary fibrosis in November 2000. This was a joint effort by the National Heart Centre, Singapore General Hospital and the National Cancer Centre.
First Mechanical Assist Device Patient To Be Explanted With The Device
 National Heart Centre’s Mechanical Assist Device Programme is the only mechanical assist device programme in Singapore which has a complete range of FDA approved assist devices available for the surgical treatment of acute heart failure, either as a bridge-to-heart transplantation or as an adjunct to recovery of the native heart function.
The Mechanical Assist Device Programme at National Heart Centre made regional medical history when the Left Ventricular Assist Device (LVAD) was successfully implanted into, and later explanted from, a patient with heart failure.
National Heart Centre Records Medical First With Air Repatriation of German Myocarditis Patient
In December 2003, a 59-year-old German tourist fell ill while in transit in Singapore. He was diagnosed to have acute fulminant myocarditis, and was transferred to National Heart Centre for further management. He developed severe heart failure that affected the other organs as well. He was implanted with a mechanical assist device ‘Abiomed Biventricular Assist Device’ which helped take over the function of his failing heart. When his condition improved, his family decided to bring him back to Germany to complete his next phase of treatment.
The patient was transported to a Swissair challenger plane at Changi Airport, where he was flown for 15 hours across 6000 miles at an altitude of 40,000 feet while being mechanically supported by the device all the time. This was an historic flight! The previous recorded longest transport with the BIVAD was a five-hour journey from Hawaii to San Diego at a much lower altitude.
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National Heart Centre First in Asia-Pacific to Implant Revolutionary Device that Reduces Risk of Strokes
National Heart Centre became the first institution in the Asia-Pacific region to implant a revolutionary device that halves the risk of stroke in patients with irregular heartbeats in March 2004.
Known as the Percutaneous Left Atrial Appendage Transcatheter Occlusion (PLAATO) device, the implant can help about 1-2% of atrial fibrillation patients who cannot undergo anti-coagulation. The device works by permanently blocking the mouth of the left atrial appendage so that blood cannot flow and clot there.
Working together with Professor Horst Sievert, a renowned German cardiologist and a pioneer with this device, doctors from National Heart Centre implanted the device in an 81-year-old Singaporean woman during its annual international cardiology conference, 13th Singapore LIVE.
National Heart Centre To Use Distal Protection Devices in Treatment of Heart Patients
National Heart Centre was one of the first few healthcare institutions in South-East Asia to introduce the use of distal protection devices, which are balloon-shaped devices that entrap the dislodged pieces of atherosclerotic tissue during the process of angioplasty.
These revolutionary devices significantly reduce the chance of released plaque components clogging up small blood vessels of the heart, hence preventing further damage to heart muscle.
Heart Patients Benefit From Cost Savings and Time with New Shared Care Programme
Launched in February 2003, the SingHealth Shared Care Programme is a collaboration between National Heart Centre and SingHealth polyclinics to take care of heart patients. Stable heart patients can go to a polyclinic near their homes for regular check-ups and repeat medications. They will still be seen at National Heart Centre, but at longer intervals. Should symptoms recur, they will be expeditiously referred back to National Heart Centre.
This programme has already benefited hundreds of heart patients in Singapore, who enjoy the convenience and cost saving. All patients with recurring symptoms has been referred back to National Heart Centre within two weeks.
National Heart Centre Offers 24-Hour Round-the-clock Angioplasty
Patients with acute heart attacks presenting early enough to hospital are eligible for emergency balloon angioplasty to open up the diseased arteries, in order to reduce the amount of heart muscle damage. This treatment procedure is available at any time of the day or night at National Heart Centre. With its team of dedicated and experienced doctors, nurses and paramedics who are on 24-hour call, National Heart Centre is well-prepared to treat heart attack cases, more than half of which occur at night.
Studies have shown that patients who undergo angioplasty are less likely to die, suffer strokes, or have recurrent heart attacks, compared to patients who receive conventional emergency drugs that dissolve clots in the heart arteries. Acute angioplasty is the better and the preferred treatment for heart attack and is available at National Heart Centre.
National Heart Centre Establishes Singapore’s First Heart Failure Programme
To tackle the growing problem of heart failure in Singapore, National Heart Centre established the nation’s first Heart Care Programme, where a team of doctors, dieticians and physiotherapists create complete tailor-made health plans for patients – from surgery to rehabilitation – to effectively manage heart failure.
This multi-disciplinary approach strives to provide personalised and comprehensive care through a structured programme to prolong survival, improve the quality of life, and reduce the hospitalisation rates of heart failure patients in Singapore.
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Improved Quality of Lives for Patients with Arrhythmia (Abnormal Heart Rhythm)
National Heart Centre is the first centre to pioneer the use of catheter ablation for arrhythmia in South-East Asia and the first to implant the implantable cardioverter defibrillator (ICD) in Singapore.
It is also the nation’s leader in arrhythmia management, which encompasses arrhythmia diagnosis, medical therapy, surgical procedures, and use of medical devices to correct or eliminate abnormal rhythms.
National Heart Centre adopts the latest treatment modalities, like biventricular pacing for treatment of heart failure, and radiofrequency ablation with Carto and Endocardial Solution Incorporated (ESI) systems in the treatment of complex arrhythmias. | |
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