Day in the life: the cardiologist and TAVI researcher

Professor Rajesh Kharbanda’s BHF-funded research is aiming to reduce the risk of stroke after heart valve replacement. He explains what a TAVI procedure is and what a typical day involves for him.

05:45

I get up at 5.45am, grab a breakfast of coffee and fruit, then drive to the John Radcliffe Hospital in Oxford, where I work as a cardiologist. I work 80 per cent of the time as an NHS doctor and the rest is focused on research.

My first meeting is at 7.30am with other colleagues running the BHF-funded research trial I work on. Since some of them are based at the London School of Hygiene & Tropical Medicine, we meet over video.

The trial is about reducing stroke risk after TAVI (transcatheter aortic valve implantation). It’s a procedure where we put in a new aortic heart valve using a catheter tube, usually going through the leg artery.

Until about ten years ago, the only option was to have open heart surgery to replace this valve. After the operation, they might have been in intensive care for up to two days, and in hospital for five or more days. Even now, if people need open heart surgery, their recovery at home can take weeks – even months. Although it’s not used for everyone, TAVI is much less invasive, and patients can go home after a day or two.

But it’s not without its risks. Up to one in 40 patients will have a stroke after having TAVI. Some small-scale trials have shown that a cerebral embolic protection device might reduce this risk. It works like a fishing net, catching debris dislodged by the catheter during the procedure, which might otherwise have reached the brain.

We’re hoping to recruit 7,730 people who are having TAVI for our trial. Half will get the device we’re testing, half won’t. By comparing their outcomes, we hope to get strong evidence whether this device does reduce stroke risk, and if so whether the NHS can use it routinely in patients having TAVI.

• Go behind the scenes with a 360-degree virtual tour of Professor Rajesh Kharbanda’s catheter lab.

© Oxford Medical Illustration

08:30

My next meeting, at 08.30am, is in person with the John Radcliffe heart team to discuss cases and decide on best treatments for patients.

The rest of the morning is spent in clinic with patients. Sometimes I’ll discuss whether they should have TAVI, and go through the risks with them. Many of them are in their 70s or 80s and their big fear is that they’ll have a bad stroke. Speaking with them makes me realise how important this trial is.

I also see patients after the TAVI procedure. Hearing that they’ve got better, that they’re no longer breathless and can get back to their hobbies is incredible. For me, the great thing about being a cardiologist is that you get to see patients all the way through their journey.

12:00

After a working lunch at my desk, going through emails, I get into my scrubs and head to the catheter lab. In one afternoon, I might perform three TAVIs. I work with a team of about eight people, including cardiologists, specialist nurses, a radiographer, physiologists and the anaesthetic team.

When I first started doing TAVIs eight years ago, they’d take a couple of hours and would be done under general anaesthetic. A surgeon would have to cut open and expose the leg arteries, as the tubes were bigger then, and patients would go to intensive care to recover afterwards. Nowadays the tubes are much smaller, and the procedure is done with the patient awake under sedation. It takes just over an hour and the patient returns to a normal ward.

I’m always in awe of how far we’ve come. Even ten years ago, I wouldn’t have imagined that you could replace someone’s heart valve with the patient awake, doing it through a hole in the leg. Now it’s routine.

15:00

The rest of the afternoon, I’m filling in paperwork. Before I leave for the evening, I go round the ward and check in on patients to see how they are recovering.

20:00

At home sometimes I need to fit in extra work for the research trial. For example, I might be looking at mock-ups of an animated video that we’re creating in different languages to help recruit participants. We want to include a broad spectrum of people in the trial to reflect the wider population.

Mostly, I try to switch off in the evenings. I enjoy cooking meals with my wife and gardening. I’m building an irrigation system for our vegetable beds that’s inspired by the human circulatory system. Pottering around the garden leaves me refreshed and ready for the next day.

• Find out more about Professor Kharbanda's BHF-funded TAVI research.

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