Surgeons may boycott a highly successful heart valve procedure unless the Federal Government makes it compulsory to use the combined skills of a cardiologist and a surgeon.

Key points: Government advisory committee recommends single principal operator for procedure

Government advisory committee recommends single principal operator for procedure Surgeons say two principal operators are needed — a surgeon and a cardiologist

Surgeons say two principal operators are needed — a surgeon and a cardiologist Surgeons warn they may boycott the procedure if two principal operators are not used

"This would be a last resort, and would be terrible for the patients," Paul Bannon, professor of surgery at the University of Sydney, told 7.30.

"I think there will be deaths and there will be patients who will suffer that could have been avoided."

The keyhole procedure, transcatheter aortic valve implant (TAVI), sees the replacement of the aortic valve without the need for open-heart surgery.

A surgeon uses a tiny wire to insert a new aortic valve into an artery, generally through the groin. It is then delicately manoeuvred up to the heart and inside the existing valve.

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'Catastrophic complications or death'

An aortic valve implant is inserted with a tiny wire in a TAVI procedure. ( ABC News )

Cardiac surgeons are at odds with the Federal Government's advisory committee, the Medical Services Advisory Committee (MSAC), over the number of medical specialists required to be involved in the procedure.

MSAC has determined only a cardiologist or a surgeon is needed to perform the operation.

But surgeons insist there should be both a cardiologist and a surgeon present.

"If you only have one person there, when you need the second person and you can't find them that will be a poor result," Michael Wilson, cardiac surgeon at Sydney's Royal Prince Alfred Hospital, told 7.30.

"There will either be catastrophic complications or death."

"If something goes bad with the heart and the heart stops beating, you've got about five minutes until you have irreparable brain damage."

"So you don't have a lot of time to muck around and find a solution and get somebody into the room."

"So we both need to be here and work collaboratively."

'No evidence to reconsider advice to government'

At the Baylor Heart Hospital in Texas specialists recommend a cardiologist and a surgeon are both involved.

"The government mandated it as a condition of payment because they listen to the professional societies," said Michael Mack, a pioneer of the technique.

"They listened to the people that were on the ground, in the trenches, performing the procedure and everybody said this is a better way of doing things."

"So government doesn't always listen, but in this instance they did, and they got it right."

But in Australia, MSAC is insisting only one principal operator is needed.

Cardiac surgeon Paul Bannon says the advisory committee ignored the advice of surgeons and cardiologists. ( ABC News )

"MSAC have decided to roll out a single operator model," Dr Bannon, who is also the immediate past president of the Australia and New Zealand Society of Cardiac Surgeons, said.

"Despite two years of advice being given by both societies, by both the Cardiology Society and the Surgical Society together on the same platform, they've decided to roll out a single-operator model where there is actually only one person at the table."

Australian chief medical officer Brendon Murphy, does not believe the twin skill sets are essential.

"I think the experience in Australia over several years where they have been many combinations, many two-cardiologist combinations, some cardiologist and surgeon combinations, are that as long as the operators are very well trained, the outcomes are fine," Professor Murphy told 7.30.

"MSAC's advice was based on a pretty confident assessment of the evidence and I don't, at this stage, see any evidence for them to reconsider."

TAVI results 'bloody wonderful'

Don Grenville was jogging just days after having his aortic valve implant operation. ( ABC News )

The operation is ideal for the elderly, who might otherwise be too frail for open heart surgery.

"It's essentially your grandmother or your grandfather," Dr Bannon said.

"It gets them out of hospital without a big operation in one or two days, instead of a week or 10 days."

Don Grenville, 94, is a living example.

Two years ago his highly active life seemed at an end as his constrained heart valve limited his oxygen supply.

"It was terrible because I'd been used to doing so much and then all of a sudden I found I couldn't do it, I was exhausted," he told 7.30.

His cardiologist, Martin Ng, said it was a "disease that suffocates you to death".

"In a very real sense the patients who suffer this condition, they can't talk to me on the phone for too long without getting short of breath, they can't do their activities of daily living without shortness of breath," Dr Ng said.

Mr Grenville had a transcatheter aortic valve implant and only days later was back jogging.

"Straight away I was able to walk and I kept going to the gym and I found that I was stronger," he said.

"And I suppose within a week I was really normal — it is amazing.

"Actually, bloody wonderful."

Surgeons warn that if the Government persists with its plan to fund single principal operators from November 1, they might boycott the procedure entirely.

"We can actually stop them going forward if we think that the program they are entering into is inappropriate or unsafe," warned Dr Bannon.

He acknowledged it would be a disaster for patients.

"But the surgeons involved and the interventional cardiologists involved would be morally and ethically bound not to allow them through to a single operator model," he said.

Professor Wilson agreed.

"I know if it was me needing the procedure, I would want two people there. Absolutely."