The surgeon with 5,000 hearts who has made the Balearic Islands a benchmark in valve restoration

José Ignacio Sáez de Ibarra has been successfully repairing 'doors' in the operating theatre for almost 25 years. He has worked on 5,000 hearts with valves that were not sufficiently closed and could be repaired. "When it doesn't close properly, the easiest thing to do is to replace it with a new one," the head of Cardiac Surgery at the Son Espases Hospital in Palma explained to ABC, comparing the simple mechanism of a door with heart surgery.

But he and his team have specialised in the opposite: preserving the gate , carving it out and leaving it working. "It's the native valve in your heart, it's integrated into that heart and it's the best gate to be there," argues the renowned heart surgeon, who has just received, along with his team, an 'Oscar' for two complex heart surgeries.

The Ministry of Health has recognised the Cardiac Surgery Service of this hospital in Mallorca as a national reference centre (CSUR) for complex cardiac repair surgery of the mitral valve and conservative surgery of the aortic valve. Both allow the correct functioning of the valves to be restored and to be preserved instead of replaced. “If it does not close properly, the hinges, the lock and, generally, the frame are adjusted, which breaks or becomes misaligned due to the force of hitting it,” continues the cardiovascular surgeon using the same simile to make the complex intervention carried out by four hospitals in Spain understandable. “Currently, only the Gregorio Marañón in Madrid, the Clínico San Carlos in Madrid, the Clínico in Barcelona and -now- Son Espases have CSUR accreditation.”

Most Spanish cardiac surgery services are experts in repair techniques, but when the anterior valve or both valves are affected - such as in Barlow's syndrome or rheumatic valvular disease - mitral valve repair or preservation of the aortic valve requires more experience and is only performed in centres with adequate training. Son Espases is one of them and will be able to operate on patients from all over Spain in these two interventions.

" Patient survival is good if the patient is operated on at an early stage and if the ventricle has not been affected. In that case, the patient has a life expectancy similar to that of a healthy person," says Sáez de Ibarra, who is already beginning to reoperate on patients who have been there for more than 20 years. "The fact that they are still alive and you reoperate on them is a beautiful thing," he acknowledges.

In order to perform these interventions correctly, a complete and multidisciplinary study is first carried out to assess the etiology, the mechanism and the possibilities of repair. Clinical cardiologists, echocardiographers and cardiac surgeons participate. "Depending on the pathology, one technique or another is adapted so that the valve retains as much of the patient's own tissue as possible."

The profile of the patient who comes to his office is people aged 45 to 65 , "although there are also many older people aged 75 or 80." The debate in this case is how far to go: "the issue is not whether we can do it technically and it works well, but rather not doing it excessively." However, he recognises that "today being 80 or 84 years old is not a limitation for having surgery , something that was 30 years ago."

More and more patients are receiving endocarditis, which is the inflammation of a heart valve. “This is happening because more and more tests are being carried out and patients are being used more and more. Every time they go for a CT scan, they put in a peripheral line, they are punctures that we put in and the serums are sources of entry for bugs into the blood and some of them lodge in the heart. This is a major health problem due to the increase in tests,” he warns.

Sáez de Ibarra arrived in Mallorca by chance almost a quarter of a century ago. He had trained in Paris, where he worked with the most cutting-edge services in Europe in valve repair. Later he spent two years working in Canada, where he received an award for his work. In 2002 he was determined to go to Barcelona, ​​but the doctor he was supposed to replace did not go. Then he was called by the prestigious cardiac surgeon Oriol Bonnín, who at that time was recruiting people to start up the Cardiac Surgery Service of the Balearic Islands in the old Son Dureta hospital.

They set up the service from scratch between four people. It was “hard” but “a nice story” because it allowed them to participate in the design of the service, led by Dr. Bonnín, and to grow until it became one of the leading services in the whole country in cardiac surgery. In 2003 they organised the first course on valve repair with live surgery in Son Dureta. They set a standard by training people and spreading the technique. Their boss always instilled in them the quality of results and respect for the patient. Ten or fifteen years went by until they moved to the Son Espases hospital, “which meant another leap in quality for Balearic healthcare”.

They started the ventricular assist programme, which has made it possible, for example, to keep young people with a heart attack alive with machines whose hearts cannot resist. "That has been very important while we make a decision about which way to go," he emphasises, and they are considering using a permanent machine, an artificial heart, or a heart transplant.

His hope now would be to open a heart transplant programme at the hospital , as currently between 10 and 15 patients a year have to go to the peninsula to receive a heart. “It would be the ultimate challenge. But you have to get a lot of people to agree,” he sighs.