National Heart Center Singapore performs advanced heart procedure, offering new hope for heart failure patients

Singapore, 27 March 2025 – The National Heart Centre Singapore (NHCS) has successfully introduced a percutaneous procedure (with a balloon and stent) that transforms how complications in mechanical heart pumps (Left Ventricular Assist Devices, LVADs) are treated, offering new hope to patients dependent on these devices. This first-in-Singapore advancement allows doctors to clear dangerous blockages in LVADs through a small skin incision; eliminating the need for major surgery. This procedure significantly lowers risk of infection, shortens recovery time from weeks to days and improves survival rates for patients with LVADs.

When a heart becomes too weak to pump blood on its own, patients often rely on these lifesaving LVADs. These devices act as a crucial support system for the failing heart, helping patients survive until a donor heart becomes available or serving as a permanent solution when transplant is not possible. While these devices offer a second chance at life, they can develop complications (such as blockages) that traditionally require major surgery to fix.

LVADs works by taking over much of the pumping function of the weakened heart. Surgically implanted inside the chest, it draws blood from the heart's main pumping chamber (left ventricle) and propels it to the rest of the body. The device runs on external batteries, connected through a cable that exits from the patient's upper abdomen. For many patients, this mechanical heart pump serves either as a bridge to heart transplantation or as a long-term therapy when transplantation is not an option.

From Open-Heart Surgery to Day Surgery: A Patient's Journey

For 42-year-old Mr Rizal, what started as mild dizziness could have led to major repeat surgery. Having lived with a LVAD since 2022, he was familiar with his device's regular functions. But in September 2024, when his LVAD began triggering frequent alarms, he knew something was wrong. “At first, I tried to brush it off," recalls Mr Rizal, who works as an administrative executive. "But when the alarms became more frequent, I was worried I might need another open-heart surgery.”

Instead, Mr Rizal became the second patient in Singapore to benefit from this percutaneous endovascular (within blood vessel) procedure. Through a small incision, doctors cleared the life-threatening blockage in his heart pump using a specialised balloon and stent – similar to treating blocked arteries, but adapted for mechanical heart pumps. "After my initial LVAD surgery in 2022, I needed weeks to recover. With this new procedure, I was back home in four days and returned to work shortly after. I can now take walks with my family and even do light exercises – faster than it would have been possible after open-heart surgery."

A Safer Alternative to Open Heart Surgery

While LVADs serve as a vital lifeline to heart failure patients, these devices can develop critical issue. Over time, material can build up between the pump’s dual- layered tubing, creating blockages that compress the inner tube and restrict blood flow and cause the pump to malfunction. When this happens, the device’s warning alarm alerts patients to a potential life-threatening situation. Previously, the only solution was to subject patients to another round of open-heart surgery – which is a high-risk approach requiring extensive recovery times and increasing risks of infection.

To solve this issue, doctors at NHCS adapted a well-established heart procedure – commonly known as the ballooning and stenting approach (typically used to treat patients with blocked blood vessels). Using this same principle, the team now applies this technique to LVAD patients. The procedure involves inserting a small balloon through a tiny incision and guiding it into the blocked LVAD tubing. The balloon is then inflated to clear the blockage, which a stent is placed to keep the passage open, ensuring the LVAD to function well.

While this technique has recently been performed in other countries, NHCS is the first to successfully perform it in Singapore. The impact to patient care is significant:  instead of undergoing major surgery that requires weeks of recovery, patients can now receive this simpler procedure and return home within days. This advancement is particularly important for high-risk patients who may be unsuitable for another open-heart surgery.

“This procedure marks a significant leap forward in how we care for our LVAD patients, said Assistant Professor Zameer Abdul Aziz, Consultant, Department of Cardiothoracic Surgery, NHCS. “Now we can treat LVAD patients with outflow graft obstructions more safely and efficiently, through a small incision, dramatically reducing surgical risks and recovery time. This allows our patients to return to their daily lives much sooner.” Asst Prof Zameer, a transplant and mechanical circulatory support (LVAD) surgeon, was part of the team - including a cardiac interventionist, echocardiologist and an interventional radiologist from Singapore General Hospital - who performed a percutaneous intervention to clear the blockage in Mr Rizal’s LVAD.

"This procedure demonstrates how multi-disciplinary collaboration can transform patient care," said Associate Professor Jonathan Yap, Senior Consultant, Department of Cardiology, and Director, Structural Heart Inventions, NHCS. "While balloon and stent techniques are well-established for treating blocked blood vessels, applying this approach to mechanical heart pumps marks a significant breakthrough. By combining the expertise of cardiac surgeons, interventional cardiologists and interventional radiologists, we can now offer LVAD patients a safer treatment option through this percutaneous procedure." Assoc Prof Yap, interventional cardiologist who was also involved in the procedure for Mr Rizal.

Singapore’s Heart Transplant Challenges

The number of patients with end-stage heart failure in Singapore continues to rise, with heart transplant waiting list growing each year as patients continue their wait for suitable donors.  While heart transplantation offers the best chance of survival, a significant gap persists between the number of heart transplants performed annually and the number of patients in need.  Currently, more than 51 patients rely on LVADs either as a bridge to transplantation or as a permanent solution or destination therapy, with many facing years of waiting for a suitable donor. 

Modern LVADs have evolved significantly, with improved technology making them reliable for long-term use rather than temporary solution. However, the success of long-term LVAD support depends critically on preventing and managing complications like tube blockages, which can be life-threatening. Hence this new percutaneous intervention procedure represents a crucial advancement in LVAD care; offering a safer way to treat complications and better support patients - both those awaiting transplantation and those depending on LVADs as their permanent solution.

“With the limited availability of donor hearts in Singapore, many heart failure patients rely on mechanical heart pumps for long-term survival,” said Assistant Professor Tan Teing Ee, Director, Heart Transplant & Mechanical Assist Device Programme, NHCS. “By introducing this percutaneous treatment for LVAD blockages or outflow graft obstruction, we are offering patients a safer, more sustainable option. This innovation reflects our commitment to advancing cardiac care and improving long term outcomes for patients with severe heart failure.” Asst Prof Tan is also the Deputy Chief Executive Officer and Senior Consultant, Department of Cardiothoracic Surgery, NHCS.

About the National Heart Centre Singapore

The National Heart Centre Singapore (NHCS) is a leading national and regional referral centre for cardiovascular diseases, offering 185 beds and a comprehensive range of cardiac care services from preventive to rehabilitative. Ranked #12 as the World’s Best Cardiology Hospital by Newsweek 2025, NHCS’s clinical outcomes are consistently recognised at the international level, meeting or exceeding global standards. It is also the only facility in Singapore providing heart transplantation programme.

As an academic medical centre, NHCS is committed to training healthcare professionals and advancing cardiovascular health through cutting-edge translational research in collaboration with local and international collaborators.

For more information, please visit: www.nhcs.com.sg