Keyhole heart valve surgery denied to 40,000 patients


More than 40,000 Britons in need of a new heart valve are being deprived of a life-saving procedure, even though it has been available on the NHS for more than 15 years.

Patients with aortic valve stenosis, when one of the heart’s crucial valves narrows and reduces blood flow in the body, have been deemed too old or frail to survive conventional open-heart surgery.

However, a much safer and less invasive – but also more expensive – keyhole treatment is rarely offered to them.

The Mail on Sunday found that just 7,000 of these procedures, called transcatheter aortic valve implantation (TAVI), take place each year, according to NHS data.

Charities say patients stuck on waiting lists are dying due to the backlog, which they say is due to NHS chiefs’ refusal to allocate more funds for the procedure.

Aortic valve stenosis is usually caused by a buildup of calcium – a mineral found in the blood – on the heart valve.

The Mail on Sunday found that just 7,000 of the procedures, called transcatheter aortic valve implantation (TAVI), take place each year, according to NHS data. Patient John Morrison (above) has died aged 69 after waiting two years for a TAVI. The County Armagh Gaelic football coach was diagnosed with aortic valve stenosis in 2016

This increases naturally with age in most people, but smoking, high blood pressure and obesity can accelerate it.

If left untreated, aortic valve stenosis, which affects more than 300,000 Britons, can lead to a number of serious conditions, including heart failure.

For the majority of patients, replacement of the faulty valve is the only effective option, and in the past this has been done by open-heart surgery – a major operation where a deep incision is made in the chest to reach the heart .

Although this procedure is almost always safe and effective, there are risks of life-threatening complications from general anesthesia, infection, or heart failure during the operation.

Patients may also take several weeks or even months to fully recover.

For these reasons, patients with aortic valve stenosis deemed too old or frail are advised that they cannot undergo open-heart surgery.

According to a study by the University of Notre Dame in Australia, which looked at UK healthcare data, more than 50,000 Britons fall into this category.

TAVI, first performed on the NHS in 2007, requires only a small incision, often in the groin. A catheter is inserted and threaded to the heart.

This tube carries an artificial valve made of animal heart tissue – usually from a cow or pig – around a deflated balloon. When the catheter reaches the defective part, the balloon is inflated, dilating the artificial valve until it is locked in place.

The technique has been shown in numerous studies to be both safe and highly effective.

Patients on average spend significantly less time recovering in hospital than those who undergo open-heart surgery and are less likely to experience complications. But those who need the operation don’t get it, experts warn.

“The bottom line is that there is an under-provision of TAVI on the NHS and it is costing lives,” says Dr Daniel Blackman, cardiologist at Leeds Teaching Hospitals NHS Trust. “Unfortunately, patients across the country die every month while waiting for the procedure.”

If left untreated, aortic valve stenosis, which affects more than 300,000 Britons, can lead to a number of serious conditions, including heart failure.  (file picture)

If left untreated, aortic valve stenosis, which affects more than 300,000 Britons, can lead to a number of serious conditions, including heart failure. (file picture)

Dr Blackman, who runs a TAVI clinic in Leeds and teaches other doctors how to perform the procedure, says the problem is that hospitals have limited resources.

“We do three days a week of TAVI and we could do four or even five,” he says. “We need additional resources, such as more hospital space and more funding. Almost all centers that offer TAVI are in the same position.

Heart charities say hospital leaders are reluctant to allocate more funds to the procedure because it is more expensive than open-heart surgery.

“Hospital managers are looking at the cost of the device itself, rather than the implied costs,” says Wil Woan, chief executive of the charity Heart Valve Voice.

“Yes, it’s more expensive than open heart surgery, but that doesn’t take into account the money ultimately saved by keeping these patients out of the hospital, not to mention the fact that TAVI patients spend less time in the convalescent ward, which frees up crucial bed space.

Patient John Morrison died aged 69 after waiting two years for a TAVI. The County Armagh Gaelic football coach was diagnosed with aortic valve stenosis in 2016.

According to her daughter, Kate Haffey, 43, doctors initially told her there was nothing to worry about.

Because John had undergone a quadruple bypass 20 years earlier, doctors deemed open-heart surgery too risky. Instead, he was told he would get a TAVI.

“Doctors said he could avoid an invasive procedure if he received TAVI and that would mean he would recover quickly,” Kate says.

But in 2018, John still had no date for the procedure and his health began to deteriorate.

“His breathing got so bad he could barely walk,” says Kate, a mother of three, a skilled worker. “We kept calling his consultant to tell him we were worried, but they still couldn’t say when he would have surgery.”

Kate says the hospital told her father there was no room for him on the ward. However, in the 50 days before his death in February 2019, he was hospitalized five times for heart issues.

Kate says: “The week before he died, his consultant said he was going on vacation and when he got back Dad could get his TAVI.”

A post-mortem examination revealed John died of arrhythmia – an abnormal heart rhythm – caused by aortic valve stenosis.

Kate says: “Dad died knowing that a procedure was all it would have taken to save him, and he didn’t understand that.”

What is the difference… between plaque and tartar?

Plaque and tartar will contribute to tooth decay if left untreated.

Plaque is basically a sticky collection of bacteria that forms a film on the teeth.

Over time, bacteria interact with the foods we eat to produce acids, which destroy enamel and lead to gum disease.

Tartar, also known as tartar, is what occurs when plaque builds up to the point of hardening and yellowing, which accelerates the development of gum disease.

The substance is so hard that it can only be removed by a dentist. Plaque, however, can be washed away with regular brushing and visits to a dental hygienist.

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