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Professor Neil Ruparelia

Consultant Cardiologist

MBBS, BSc (hons), PhD / DPhil, MRCP, FESC

Practices at: Circle Reading Hospital

A photo of Professor Neil Ruparelia

Professor Neil Ruparelia was awarded his medical degree from University College London in 2004 and an intercalated degree (BSc) in Medical Law receiving numerous prizes. He completed specialist training in cardiology in Oxford with specialist interventional fellowships at the Hammersmith Hospital, London and a year in Milan, Italy at the world-famous San Raffaele Scientific Institute during which time he was awarded a MSc in interventional cardiology.

He was awarded a DPhil (PhD) from Balliol College, University of Oxford funded by a British Heart Foundation Clinical Research Fellowship. During this time, he was also the recipient of a British Heart Foundation travel fellowship to the Broad Institute (MIT) and Harvard Medical School (Boston, USA).

He was the winner of numerous prizes including President's Gold Medical in Cardiology from the Royal Society of Medicine and investigator prizes from the European Society of Cardiology (ESC), American Heart Association (AHA).

He is an author of over 100 publications including original papers, editorials, review articles and book chapters and is regularly invited to speak at both national and International conferences and act as a reviewer for a number of international medical journals.

In 2017 he was awarded Fellowship of the European Society of Cardiology (FESC) and appointed Consultant Cardiologist between the Royal Berkshire Hospital, Reading and the Hammersmith Hospital, London and in 2018 appointed Honorary Senior Clinical Lecturer at Imperial College London.

Neil is married with two boys. He enjoys playing sport (golf and football), attending the gym, reading and travelling.

Professor Neil Ruparelia's clinical interests are:

  • Percutaneous coronary intervention (PCI): including chronic total occlusion (CTO) PCI, coronary physiology assessment, intravascular imaging (IVUS/OCT), rotational atherectomy (rotablation), bifurcation stenting and left main stem intervention.
  • Transcatheter aortic valve implantation (TAVI)
  • Patent foramen ovale (PFO) closure
  • Atrial septal defect (ASD) closure
  • Permanent pacemaker implantation
  • Transthoracic and transoesophageal echocardiography
  • Percutaneous paravalvular leak (PVL) closure

His research interests are:

  • Basic science: innate immune response to ischaemia
  • Translational research: the applicability of experimental models to human disease
  • Clinical research: clinical trials including first-in-man studies and evaluation of novel therapeutics
  • Research supervisor

His current NHS positions are as follows:

  • Consultant Cardiologist at the Royal Berkshire Hospital, Reading.
  • Consultant Cardiologist at the Hammersmith Hospital, London.
  • Honorary Senior Clinical Lecturer, Imperial College London.

His first medical qualification came in 2004.

  • Fellow of the European Society of Cardiology
  • Royal College of Physicians
  • British Cardiovascular Society

The procedure of coronary stent implantation (or PCI – percutaneous coronary intervention) is a treatment option in the management of coronary artery disease. Also known as ischemic heart disease, this condition involves the build-up of plaque in the arteries of the heart, leading to reduced blood flow through the heart.

It’s one of the most common heart conditions, and its symptoms often present as stable angina - recurring exertional chest pain (or breathlessness) and a feeling of uncomfortable pressure in the chest. In some instances, where there has been a limited response to medical therapy or due to the location of disease, I would recommend coronary angiography and perform coronary stent implantation if appropriate. 

However, it’s important to clear up some misconceptions about this procedure.

Stent implantation is all about improving your symptoms and quality of life. One of the most common misconceptions about coronary stent implantation in stable disease (as opposed to heart attacks) is that stents cure the furrings of arteries, prevent further heart attacks, and make you live longer. That’s not necessarily the case.

Rather than solve those issues, the aim of stent implantation for stable angina is to improve recurring symptoms, make you feel a lot better, and reduce the amount of medication needed to cope with angina. 

You may read alarming things in the newspapers and see conflicting information, or read stories that apply to different people in different situations. So I aim to clarify things for you specifically, so we can give the best treatment for you.

I perform a lot of procedures and interventions, but I devote a lot of my time explaining the pros and cons of the interventions, addressing any concerns and managing expectations.  

So I might actually recommend against stent implantation, depending on your circumstances. But if we decide that you would benefit from such an intervention, and you’re in agreement, you’d be booked in to hospital for a day case procedure.

Your first appointment

Firstly, I'd spend a good part of our initial appointment explaining what the concerns are about your condition and its treatments, what the investigations are for and why we do them, and what the resultant action will be depending on their outcome.

Before embarking on a procedure, we'll spend some time exploring a few concepts. Firstly, why it is that we do this procedure and not something else, and how this fits in with your overall management plan including medical therapy and lifestyle modifications. That’s important to clarify, especially if you’re worried or were expecting a different course of action.

We’ll talk about what the benefits are from a stent implant, and how they might improve your quality of life. We’ll also explore what the risks are, both in general and specifically for your condition; and finally, what the alternatives are to stent implantation - there may be other options available. Stent implantation might be the right choice for you, but I’ll always go through what the other alternatives could be, so we have all the possibilities covered.

We’ll cover everything else including the ‘if's, 'but's, 'what if's and 'when's, so there are no surprises, and you always know what to expect further along the journey. 

How coronary stent implantation is done

On the day of the procedure, you’ll arrive at the hospital first at the specified time. You’ll have some routine observations performed and final checks to ensure that you are still agreeable to the procedure (consent) and that you are being treated with the correct medications.

The procedure itself will be performed under a local anaesthetic for your comfort (which means you’ll be awake for the procedure but won’t feel pain) and is achieved by inserting a small plastic tube, called a catheter, into the wrist that facilitates the advancement of wire, balloons and stents into the heart arteries. We use an x-ray video device to monitor its progress.

The stent is a short tube made of wire mesh. When it’s in place, a very small balloon in it is gently inflated, so the stent widens the artery. The balloon is then deflated and removed. The stent is then left in place permanently to help the blood to flow more freely through the arteries.

The procedure normally takes an hour or so and is not unduly uncomfortable. 

What happens after your coronary stent implantation?

Immediately after the procedure, you should be able to sit up, rest for a short while, and you’d hope to be on your way home within four hours of the process.

You’d also be able to eat and drink straight afterwards, too, so you won’t have to go without for too long at all. The only thing I’d recommend during the following week is to avoid strenuous activities like heavy lifting or exercise.

I’d then follow up in a few weeks with you afterwards to see how you’re feeling and how you’ve recovered. This would ideally be in person but can also be done over the telephone.

We’d also review your medications and ongoing management of your condition, to see how they’re working for you. This helps to reduce the risk of further recurrences of your condition, and improve the process of your recovery. If there are any issues, I’d take this opportunity to recommend further courses of action. Should all be well, you can be on your way, getting back to your usual routine with a much-improved quality of life.

Transcatheter aortic valve implantation (TAVI) is a procedure intended for the treatment of severe symptomatic aortic stenosis - the natural narrowing of the aortic heart valve. 

This narrowing of the aortic heart valve, known as aortic stenosis, can cause a gradual onset of symptoms. When mild or moderate it’s of no clinical concern. However, when this progresses to the severe range it can result in symptoms including exertional breathlessness, chest pain, or losing consciousness when sitting or standing. It can then progress into more severe episodes of syncope (fainting spells), low blood pressure, or other undesired symptoms. 

Historically, the only treatment for this was an open surgical aortic valve replacement. This is still first-line therapy for the majority of patients, however, patients with signs of aortic stenosis are often in their senior years - in their seventies, eighties or nineties. This means they might also have other medical conditions or complicating factors going on, which means a significant operation like open heart surgery isn’t appropriate. The problem in this case is that untreated symptomatic severe aortic stenosis if left untreated is associated with a poor outcome.

That’s where TAVI comes in. The procedure is sometimes referred to as transcatheter aortic valve replacement (TAVR). Essentially, it involves the replacement of the aortic valve of the heart by transporting an implant through the blood vessels - a less invasive method than open heart surgical alternatives.

Your first appointment

Firstly, I'd spend a good part of our initial appointment explaining what the concerns are about your condition and its potential treatments, what the investigations are for and why we do them, and what the resultant action will be depending on their outcome.

Before embarking on any procedure, we'll spend some time exploring a few concepts. Firstly, why it is that we'd do this procedure as opposed to an alternative. That’s important to clarify, especially if you’re worried or were expecting a different course of action.

We’ll talk about what the benefits are from a valve implant, and how they might improve your quality of life and long-term outcome. We’ll also explore what the risks are, both in general and specifically for your condition. TAVI might be the right choice for you, but I’ll always go through what the other alternatives are, so we have addressed all of the possibilities.

We’ll cover everything else including the ‘if's, 'but's, 'what if's and 'when's, so there are no surprises, and you always know what to expect further along the journey.

What happens during your TAVI procedure

If we agree on transcatheter aortic valve implantation, the first thing we’d do would perform further tests to understand the condition of your heart, including a CT scan and heart scan. Additionally we shall perform some bloods tests and lung assessments to aid in procedural planning and to assess risk.

On the day of the procedure, you should not eat or drink for a minimum of 6 hours prior to procedure time. Following admission, routine observations will be taken, and I shall meet you to talk through any final concerns and ensure that you are still happy to proceed (consent). You will be then taken to the operating room and after some final checks we’ll commence.

As mentioned, TAVI is a minimally invasive procedure compared to open heart surgeries. It normally takes an hour or two to complete, and is usually done with anaesthetic help to try and keep you as comfortable as possible.

The valve that’s to be implanted is attached to a catheter. This is inserted into a blood vessel - often the femoral artery, which is accessed via the groin, although sometimes a small opening in the chest is used (without disturbing the bones in the chest).

The device is then slowly introduced upwards towards the heart, when it reaches the area of the aortic valve. When it’s in place, the new valve is deployed in place of the diseased native valve. This helps the valve open up and settle into place. After this, the catheter is gently removed and openings are closed up.

This has a quicker recovery time than open heart surgeries, too - we’d expect you to go through two or three days of recovery in hospital before getting home.

What happens after your TAVI procedure?

I would meet with you a couple of weeks afterwards to make sure that the valve is working well, by going through a heart scan and clinical examination. We’d also review your medications to see how they’re affected and what your ongoing medication options might be. As well as these, we’d also go through any other possible long-term therapies that might be suitable for you.

The procedure itself is designed to be a one-off. Despite being a newer procedure than some other heart treatments, the longevity of the valve implants used in TAVI whilst currently is limited to 8 years have had some really positive results so far. While there is always a slight risk of failure, it’s uncommon and we do keep you under long-term surveillance, so you’d reasonably expect to only have to undergo a TAVI procedure once.

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