Revolutionising heart surgery through endoscopic innovations with Mr Toufan Bahrami

THSC_Mr Bahrami_Nov 23_001.jpg

It was during the third year of his medical studies Mr Toufan Bahrami became certain he wanted to specialise in heart surgery. He remembers a Christmas Eve when most consultants had gone home. The cardiothoracic surgeon he was observing, however, was determined not to delay his patient’s surgery, and explained the intense pressure he faced to get every move right. “I was impressed. This is a speciality where you can’t wait,” Mr Bahrami explains. “And also where if you make a mistake, there is no second chance.”

He had wanted to become a heart surgeon since he was a boy of 12 growing up in France. “My teacher joked I might want to complete my exams first,” he laughs. Absorbing the expertise of the specialists he trained under at the Pitié-Salpêtrière University Hospital, Paris, and later at the UK’s Royal Brompton and Harefield hospitals, the UK’s largest specialist heart and lung centre, cemented this.

Now, 24 years after his arrival in Britain, a consultant cardiothoracic surgeon leading a prestigious team at The Harley Street Clinic, part of HCA UK, Mr Bahrami has conducted over 4,000 heart operations. That is some 220 a year while the average consultant carries out around 80. He admits a never-ending desire for personal betterment and optimising the outcomes for his patients is what drives him. “Doing more brings more experience, more expertise. You have seen complications, you can predict them, and you become faster and more confident,” he says.

His unwavering commitment has led him to compile a list of UK and worldwide ‘firsts’. In 2009, he carried out the first double lung transplantation from a person with a non-beating heart in Britain. “That increased the number of lung transplants in the UK by 20%,” he explains.

Consultant in theatre

However, it is in the area of minimally invasive heart surgery where he has proved most prolifically pioneering, leading the way from traditional open-heart surgery, sternotomy, in which a surgeon makes a long incision up to 20cm down the breast bone, to groundbreaking procedures which allow for chest incisions as small as 2.5cm.

He now regularly performs totally endoscopic heart surgery, which uses a high-definition 3D camera on the end of a slim, flexible tube, inserted into the chest through a small incision. This allows him to work with the utmost precision following 3D imagery on a screen. His expertise has placed The Harley Street Clinic at the forefront of this new technology. “I had the choice - to do things like everyone else, or change things,” he explains.

In 2007, Mr Bahrami carried out the UK’s first endoscopic vein harvesting surgery, in which a vein from the leg is taken to use as part of a coronary artery bypass graft. Now he says The Harley Street Clinic is the only private sector hospital to offer it to 100% of patients.

In a worldwide first, in 2016 he implanted the first replacement INSPIRIS RESILIA aortic valve using a minimally invasive technique. “Today we do it on every patient having aortic valve surgery at The Harley Street Clinic,” he explains. In November 2023, he carried out the same procedure for the mitral valve, becoming the first in the UK to do so within the private sector. The list goes on, including world firsts in minimally invasive off-pump coronary artery bypass grafts, and mitral valve repair. Today, The Harley Street Clinic is the only private hospital in the UK offering totally endoscopic valve repair. It even uses the process for the removal of the rare heart tumour, myxoma.

Mr Bahrami is now the president of The British And Irish Society for Minimally Invasive Cardiac Surgery (BISMICS). For patients, the benefits of minimally invasive surgery are life-changing, he explains. Scarring is kept to a minimum or is non-existent. There is “less bleeding, less infection, less pain.” But, he says: “The most important benefit is faster recovery. That is crucial for patients who want to get on with their lives, who don’t want to spend three or four weeks in hospital.”

Describing traditional surgery, he says: “When we open the breast bone from the neck down and spread the ribs, patients cannot lift heavy things for two months, they cannot sleep on their side for two months, or drive for two months. A full recovery comes in three to four months.

“But with minimally invasive surgery - and endoscopic even more so - you can lift anything you want, sleep on your side, breathe better, and you can drive within three weeks. You are back to work within a month.”

These days, he smiles, smart watches offer encouraging proof. “How many steps can people do within two weeks post discharge, three weeks after the procedure?” he asks. “After minimally invasive surgery they can do 10,000 steps a day, whereas following sternotomy it is 1-3,000.” A recent myxoma patient is now walking for up to two hours a day, nine days after surgery.

And surgical safety remains the same, he says. “Less bleeding, less infection, less stroke risk,” he explains. With safety always in mind, he also insists on working with the same team at The Harley Street Clinic so they can coordinate seamlessly. “Everyone has to be familiar. Everyone can see the screen and follow the operation,” he describes. “We haven’t had a single complication, not even a wound infection.”

Mr Bahrami will never stop innovating; his next exploration is towards greater dependence on robotics. But it is human excellence, his team’s and his own, he will always prize highest.