Watchman implant reduces heart bleeding risks

A surgical alternative to taking powerful blood thinners for patients with irregular heart rhythm and at high risk of bleeding has been carried out for the first time in a Singapore private hospital.

Cardiologist Dr Paul Chiam carried out a Watchman implant—a percutaneous technique of closing the left atrial appendage (LAA)—into Tang Chue Ngan, an atrial fibrillation (AF) patient, at Mount Elizabeth Hospitals. Tang had been experiencing symptoms (bleeding) caused by her use of a blood thinner.

The low-risk procedure required the patient to stay just one night in the hospital. Subsequently, she has reported a fast and smooth recovery.

Watchman implant

Approved in 2015 by the US Food and Drug Administration, the Watchman is a one-time implant similar to a stent that is guided into the heart through a flexible catheter inserted into the femoral vein in the upper leg. After being introduced into the right atrium, it passes into the left atrium through a puncture hole, where it is released and left fixed to the heart.

“In AF, a relatively common irregular heart rhythm, clots can form in the heart, and 90 percent of these clots form in the LAA. These clots can then travel from the heart to the brain and cause a stroke,” said Dr Chiam.

“To reduce the chances of a stroke, we use powerful blood thinners like Warfarin. However, many patients, especially the elderly, are at increased risk of bleeding when taking these blood thinners or actually develop bleeding.”

These patients would be good candidates for the Watchman procedure to “seal off” the LAA, making a stroke less likely without the need for a powerful blood thinner.

Though there is a possibility the procedure could damage the LAA and cause bleeding around the heart, requiring urgent drainage, the Watchman implant carries a very low risk.

But because of the novelty of the procedure and a shortage of physicians in private practice with experience of structural heart interventions, it had not been carried out in Singapore’s private hospitals until Dr Chiam’s operation on Tang.

Patient presents

Having received an open-heart valve replacement six years ago, the patient developed AF after the surgery and began oral anticoagulation. She experienced some transient minor strokes in the interim and was recently admitted to hospital for bleeding from the gut.

“Thus she was a suitable candidate for the Watchman procedure, as she experienced bleeding while on oral anticoagulation,” said Dr Chiam.

Disappointed with the treatment she received at the public hospital where she was initially admitted, Tang sought a second opinion from Dr Chiam after she was taken off her blood thinners.

“He patiently explained to me my cardiac condition, the blood thinning and its bleeding threats, and also the danger of future blood clots threats. He described the solution that would help to ease the bleeding,” she said.

Back to normal life

The patient was released the day after the implant was performed under general anaesthesia in Mount Elizabeth’s cardiac catheterisation suite. She was told to return a month later for a check-up, followed by a transesophageal echocardiogram 45 days after the procedure, at which point she could discontinue using the powerful blood thinner.

Delighted with the outcome, Tang is pleased to have been part of this pioneering surgery in a private hospital in Singapore.

She urged other patients in a similar position: “If you feel the advice by the doctor is beneficial, have confidence and take advantage of the treatment options. We have good medical care in Singapore.”

Dr Chiam is a cardiologist at Mount Elizabeth Hospitals, Singapore, subspecialising in interventional cardiology. He graduated on the Dean’s list from the NUS Faculty of Medicine, and was awarded the Gold Medal in the postgraduate Master’s of Medicine, NUS. Having performed the first transcatheter aortic valve replacement in Asia in 2009, he currently teaches the procedure across the region. He also lectures at the Yong Loo Lin School of Medicine, NUS, in his capacity as an adjunct associate professor.

Mount Elizabeth Heart And Vascular Centre

3 Mount Elizabeth #08-06
Mount Elizabeth Medical Centre
Singapore 228510

Tel: (+65) 6735 3022