Cardiovascular Procedures

Our highly skilled cardiac surgeons specialise in performing surgical treatments using the latest advances in cardiac surgery. While we specialise in treating adult congenital heart disease, our surgeons are experienced at successfully executing a wide range of procedures including Coronary Artery Bypass Grafting or CABG as well as Aortic and Mitral Valve Repair and Replacement. We specialise in minimally invasive cardiac procedures and always recommend procedures involving the least risk for any patient.

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This procedure is done when the coronary artery is damaged and no longer supplies oxygenated blood to the rest of the body. By performing a revascularization, the flow of the blood will be restored, as new blood vessels are placed around the existing blockages. This allows the heart to function optimally and lowers your chance of a heart attack. The surgery can take three to six hours to complete.
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Coronary artery bypass grafting (CABG) is a type of heart surgery for patients suffering from severe coronary heart disease (CHD). CHD narrows large arteries, in turn restricting the blood supply to vital organs and the heart muscle. This can lead to chest pain and fatal heart attacks. We can perform on and off-pump procedures to reduce the risk of a heart attack and improve your blood flow.
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Vein harvesting involves taking a vein from the leg and using it as a bypass graft for the narrowed coronary artery. Conventionally, this vein was harvested from the leg and thigh using long cuts along its course. These cuts often left unsightly scars. In the mid-nineties, endoscopic techniques, using video cameras, were introduced into practice, to ensure that vein harvesting was made less invasive. Endoscopic Vein Harvesting usually involves making two to three 1-2 cm incisions to remove the vein from the leg and thigh. This technique has proven to be as effective as the conventional approach, but with better cosmetic appearance and fewer complications when carried out by experienced hands. We have a team of surgical care practitioners who are well-trained in this technique, lead by the highly-experienced Mr Aliar.

Mr Afsar Aliar - Surgical Assistant

BSc (Surgical Assistance), HNDip (Cardio Thoracic Surgery Assistance)


Specific Cardiovascular Interests

Endoscopic Vein Harvesting, Coronary Artery Bypass (CABG), Type A Aortic Dissections and Thoracoabdominal Surgery.


Biography

Afsar Aliar graduated as a Surgical Assistant in 2009 from Greenwich University, London. He then passed his National Diploma examination for Cardiothoracic Surgical Assistants in 2009 and was awarded a distinction by the Royal College of England and the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS).

After completing his Diploma in 2009, he joined the Central Manchester University Hospitals (CMFT) as a surgical assistant. The next year, he trained in Endoscopic Vein Harvesting (EVH) for Coronary Artery Bypass Grafting (CABG) procedures at the Munich Heart Centre in Germany.
He is the most experienced Endoscopic Vein Harvesting practitioner in the country and has performed more than 500 EVH vein harvestings with incisions of less than 2 centimetres. He has harvested more than 2000 conduits including long Saphenous Vein Grafts (SVG), radial arteries and Short Saphenous Veins (SSV).
He is also an EVH proctor and has trained more than 10 people in the UK and internationally in this minimally invasive technique.

Contact Details

Email: afsar.aliar@cmft.nhs.uk
Secretary: Elaine Daly
Phone: 0161 276 8907
Email: elaine.daly@cmft.nhs.uk
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We carry out aortic vascular surgery for patients suffering from thoracic and abdominal aortic aneurysms. An aneurysm is a swollen artery, that, if left untreated, may burst. This causes blood to leak into the chest or abdomen and subsequent blood loss. In some cases, a blood clot can also form within the dilated artery. Tears, known as aortic dissections, can also form in the aorta, resulting in complications, which, if not treated immediately, can be fatal. Therefore, we often perform emergency procedures to repair aortic dissections.

Manchester Cardiac Surgeons are able to carry out a variety of procedures depending on the location of the aneurysm and its severity. These operations usually take between 2 to 8 hours to complete. Our surgeons will either attempt to repair the artery or replace it with a synthetic tube. Patients usually require 4 to 6 weeks to recover fully from major aortic vascular surgery.
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A type A aortic dissection is a tear in the thoracic aorta that is fatal if left untreated. Therefore, it is treated as an emergency, avoiding any possible delay. The dissection normally presents itself as sharp tearing pain in the chest radiating to the back. A computed tomography scan provides the diagnosis. Our trained aortic surgeons provide a specialised aortovascular service, performing type A aortic dissection repairs 24/7 any day of the year.
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Valve-preserving aortic root replacement is a type of major aortic vascular surgery. Solving the problems caused by aortic root aneurysms, bulges in the section of the aorta closest to the heart, is often complicated because this part of the aorta is close to the heart valve. Our surgeons have the expertise to preserve the aortic valve while replacing the section of dilated aorta.
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Thoracic aorta replacement is a type of major aortic vascular surgery. The function of the thoracic aorta is to provide the entire chest area with oxygenated blood. When an aneurysm forms in the thoracic aorta, this sometimes causes pain in the chest or back. We are able to replace the dilated sections of the thoracic aorta with blood vessels harvested from other locations in the body, thereby improving the circulation in the chest area.
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Aortic arch surgery is a type of major aortic vascular surgery. The aortic arch supplies blood to the head and the arms. If the walls of the aortic arch widen, this can cause chest pains, inconsistent blood pressure, fatigue and difficulty breathing. Our surgeons are able to repair the arch by replacing the affected area with synthetic material. Usually, open heart surgery will be required and patients will need to be hooked up to a heart-lung bypass machine. In some cases, a minimally invasive approach can be used and patients will not need to put on the bypass machine. In these procedures, a metal wire mesh is inserted to help halt the dilation of the aorta.
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Hybrid aortic vascular repair is a type of major aortic vascular surgery. Depending on the complexity of the surgery and the frailty of the patient, our surgeons may recommend a hybrid aortic vascular repair. This involves a conventional open heart surgical procedure followed by an endoscope procedure. Hybrid procedures minimise the risks and recovery times for patients who need complex vascular repairs.
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The function of the aortic valve is to regulate the flow of oxygenated blood from the heart to the aorta. There are two reasons the aortic valve may need to be repaired or replaced. The first is aortic stenosis, which occurs when the valve has become narrow and obstructs blood flow. The second is aortic regurgitation, which causes blood to leak back into the heart. Untreated damaged aortic valves can lead to severe problems such as heart failure, therefore we recommend that diagnostics be run as soon as possible to see if an aortic valve repair or replacement might be necessary.

Our cardiac surgeons are able to carry out both aortic valve repairs and replacements, depending on the severity of the deformity or the damage. They always aim to use minimally invasive techniques to ensure that risks, pain and recovery times are minimised.

If the surgery requires too much complex work the chest area will need to be opened to access the heart. Because the heart will need to be stopped, a heart-lung machine will be used to regulate breathing and blood circulation. This type of surgery will likely take about 3 to 6 hours to complete. However, we always attempt to use the most minimally invasive techniques possible. With these types of procedures, only a small incision is made. The heart will not need to be stopped and no bypass machine will need to be used. The surgery will also only take about 4 hours.

On average, it takes between two to three months to recover from an aortic valve repair or replacement surgery. However, patients are able to sit up a day after the procedure and can expect to return home within a week after the procedure. This will involve some discomfort, but they will have some freedom of movement during the recovery period.
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Since 2002, a new technique using transcatheter techniques has been used for replacing aortic valves. It was initially introduced for patients who were considered very high risk for conventional aortic valve replacement through the breastbone using the heart and lung machine. TAVR has proven to be successful, and it is now used for intermediate risk patients. It can be performed through the arteries in the groin, the arteries on top of the chest or through a small cut in the chest.

The Manchester Royal Infirmary, where our team operates, is one of the largest recruiters of the UK TAVR Trial. Our specialised TAVR Multidisciplinary team (MDT) consists of 2 surgeons, 2 cardiologists, 1 radiologist, an imaging specialist and a dedicated patient liaison team. These specialists meet on a weekly basis to discuss patients referred for TAVR.

Our experts perform TAVR through various routes such as through the thigh (Transfemoral), the upper arm (Trans-subclavian) or through the chest (Transaortic). All these procedures are carried out through a small incision measuring between 2 or 3 cm. Our mortality rate for third generation (Sapein 3) TAVR devices is less than 1%.
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The mitral valve controls the blood flow from the collecting to the pumping chamber within the heart. It is made of two 2 leaflets supported by strings attached to the heart muscle, much like 2 sails with their supporting ropes. The valve could be affected by diseases that cause either leaking, constriction or a combination of the two. We strive to repair the valve whenever possible. However, sometimes it is necessary to replace the valve using a tissue or mechanical valve.

Our 2 dedicated mitral valve repair surgeons have together have completed over 1000 cases. While the national average repair rate is around 60%, between 2014 and 2015, they achieved a repair rate of more than 80%. Our Mitral Valve Multidisciplinary Team (MDT), which consists of 2 cardiologists, our 2 surgeons who specialise in mitral valve repair and an imaging specialist, also meet to look at every mitral valve case to provide the best and safest possible care.
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Some patients who have undergone cardiac surgery might require repeat operations due to their existing condition or a new one. These operations are usually carried out through the previous incision or sometimes using an alternate approach if this is deemed more appropriate. We have significant experience carrying out re-do cardiac surgeries and have achieved excellent results for these patients.
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Our surgeons specialise in treating adult congenital heart diseases. These are defects of the heart or blood vessels which develop before birth. The most common congenital heart diseases affecting our adult patients include:
  • Bicuspid Aortic Valve Disease (BAVD) - This occurs when individuals are born with two aortic valve leaflets instead of three. This means that the valve doesn’t function properly and patients are at risk of forming abnormal coronary arteries and unstable blood pressure. Depending on the severity of the disorder, the aortic valve might need to be replaced. Sometimes a coronary artery bypass surgery might also be necessary. Surgical treatment for this disorder can take anywhere from 2 to 6 hours depending on the nature of the defect. Depending on whether open-heart surgery or minimally invasive procedure were used, recovery can take anywhere from 12 weeks to 1 month.
  • Atrial Septal Defect (ASD) - Patients with this disorder are born with a hole between the upper left and right chambers of the heart’s muscular wall. Many atrial septal defects close on their own, however, consistent monitoring is required to ensure that it is not causing any severe health issues. Arrhythmia and stroke are potential risks of ASD. Our surgeons are able to carry out catheter procedures to repair the aperture if the patient is experiencing problems. These procedures can take from 1 to 3 hours depending on the complexity of the situation and the size of the ASD. It can take up to a month to recover fully.
  • Patent Foramen Ovale (PFO) - The foramen ovale is a small hole located in the muscular wall of the heart which all children are born with. However, in some cases, this hole does not close. This is known as a ‘patent foramen ovale’. A PFO puts patients at risk of a stroke or heart attack. Our cardiac surgeons can perform a catheter-based procedure taking about 1 to 2 hours to repair the opening. Recovery takes about a month.
  • Coarctation of the Aorta - This is a relatively common congenital disorder, wherein normal blood flow is restricted as a result of the aorta being pinched or narrowed. If untreated for an extended period, it can lead to kidney and liver failure. Our surgeons are able to repair the coarctation either by extending the constricted area or by removing it and attaching the 2 ends to one another. Surgical treatment for this disorder usually takes about 2 to 3 hours to complete. Usually, recovery only takes a month if a minimally invasive procedure was conducted.
  • Ebstein’s Anomaly - In patients with this disorder, the leaflets of the tricuspid are abnormally formed. Surgery might be required, depending on the severity of the patient’s symptoms. In some cases, patients are at risk of heart failure. Our specialists are able to provide assessment and advice, as well as tricuspid valve repair or replacement if surgery cannot be avoided. Tricuspid valve surgery usually takes about 2 to 4 hours. If minimally invasive techniques are used then recovery will take about 4 weeks. However, if open heart surgery was needed, it will take at least 3 months to recover fully.
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Contact Us

Tel: 07751315816
Email : haris@mcsurgeons.com
haris.bilal@mmu.ac.uk