Setting the pace of cardiology

Completing his undergraduate training at Guy’s and St Thomas’ Hospital’s Medical School in London (now part of GKT School of Medical Education) and then undertaking postgraduate placements at leading specialist cardiac centres, it is clear he has that same job satisfaction. And nowhere more so than at HCA Healthcare UK’s The Harley Street Clinic.

It is here that the Fellow of the Royal College of Physicians practices the most progressive advancements in his field of expertise, not least the implementation of transcatheter aortic valve implantation (TAVI), a non-surgical heart valve intervention. Dr Firoozi, who won a fellowship from The British Heart Foundation early in his career, has now conducted over 2,000 TAVI procedures.

TAVI avoids the need for open heart surgery and general anesthetic in cases of failing aortic valves. Using a narrow, flexible tube, or catheter, inserted into an artery in the groin, it is designed to treat cases of significant aortic valve stenosis, a thickening and progressive restriction of the valve — the most common valve disease impacting older patients. If left untreated, this can result in heart failure and death. 

The catheter is passed down towards the heart in order to insert an artificial replacement valve. When a case is straightforward it can be performed within 90 minutes. Patients are usually sedated or given local anaesthetic, and are encouraged to sit up later that day, spending just two days on average recovering in hospital. 

The short-term benefit is less invasive surgery. The longer-term benefit of TAVI in those individuals unfit for surgery results in an especially high mortality benefit, with this group demonstrating a 50 per cent reduction in death rate after one year. 

HCA UK’s The Harley Street Clinic performs around 100 TAVI procedures annually, with emphasis on a patient’s individual needs. Rapid access to treatment is the cornerstone of its care. Dr Firoozi describes: “We have the ability to see patients and offer them diagnostics very quickly. In most cases, patients can have all the tests they need within a few days”. 

He adds, “We run a dedicated TAVI multidisciplinary team meeting each week where myself, other cardiologists, anaesthetists, radiologists and vascular surgeons get together and discuss the patient’s case in detail to come up with the best treatment recommendation. We can do this in a very short period and it is bespoke.”

He explains speed matters. “Similar to cancer, aortic stenosis is a condition where there can be a worsening of symptoms and clinical deterioration while on a waiting list. Getting a patient’s TAVI done rapidly matters more than most cardiac procedures.” 

The clinic is also at the forefront of new technology within the TAVI arena. In November 2023, Dr Firoozi performed the first TAVI procedure in England using a new valve manufactured by Medtronic, the Evolut™ FX. 

“The equipment we use is the latest in the field, and the best. The difference with this device is in the design of the catheter and delivery system used to get the valve in the right place. It is more flexible and less likely to cause damage to the femoral artery in the groin. It enables a safer deployment. For the patient, this means a shorter procedure and better end result.”

Dr Firoozi has also begun practicing a similar type of procedure for mitral valve disease - the most common type of heart valve disease across all age groups. When a patient has leaky mitral valves — otherwise known as mitral regurgitation — and is unfit for mitral valve surgery, a minimally invasive option using a catheter inserted through the groin is available. This procedure is referred to as mitral transcatheter edge-to-edge repair (mTEER), or MitraClip™.  

The procedure clips together two of the valve’s “leaflets”, the flaps of tissue which open and close during each heartbeat, thereby reducing leakage. 

“This time we go into the vein rather than the artery, so there is less risk of bleeding…” Dr Firoozi explains. “This is a relatively new, but rapidly evolving arena of work within interventional cardiology, and if performed in the correct patients, offers real benefit.”

The clinic is also at the forefront of coronary angioplasty procedures, used to widen narrowed coronary arteries. For the last two years, it has implemented ultrasonic lithotripsy balloon therapies to treat calcified, hardened arteries.

The procedure, which carefully breaks up calcium along coronary artery walls, can be as brief as 30 minutes and see patients return home the same day. “It involves a balloon which is covered in emitters which give off sonic or sound waves. These waves break up the calcium. This technology has proven to be a real game changer and the safety profile is really impressive.” 

“The procedure is shorter and results in stents being fully expanded so long-term outcomes for patients are improved. Patients have a longer period without symptoms, or without having to undergo further procedures.”

Unsurprisingly, the doctor has little time for relaxation. When not practicing, the British Cardiovascular Intervention Society (BCIS) and British Cardiovascular Society (BCS) member has a passion for teaching – to date, Dr Firoozi has trained up to 25 consultants. He is also involved in innovative research, and is a principal investigator in a number of leading national and international trials in AI and computer simulation. 

But he is also a family man who loves to play tennis in what spare time he has. And is his mother proud of all he has achieved since those days at the dinner table? “I think so” he smiles.

Find out more about Dr Sam Firoozi’s work in interventional cardiology at HCA UK’s The Harley Street Clinic.