Heart valve service
We perform a large number of surgical and transcatheter aortic valve replacements each year. In 2021 alone, we treated over 1,000 patients for valve repair or replacement.
We put the patient at the heart of everything we do, bringing together all of the expertise needed to look after you, including cardiothoracic surgeons, structural interventionalists, cardiologists, radiologists and cardiovascular imaging experts, many of whom are leaders in their field.
Physician and physiologist clinics are held on the same day, so you can get the tests you need quickly and minimising the number of times you have to come to hospital. There are often multiple treatment options available, and we will always work closely with you to ensure it's the right choice for you.
We treat all forms of valve disease including mitral, aortic, pulmonary and tricuspid valve disease. For more information on the signs and symptoms, visit the British Heart Foundation.
Your tests and investigations
There are many tests which can be done to look at various different aspects of your heart. At Barts Heart Centre, we have state-of-the art equipment and technology and our cardiovascular imaging labs are internationally recognised.
Tests you may need include:
This is an invasive procedure where a tube (catheter) is passed through a blood vessel (artery) in your arm (radial) or groin (femoral) to visualise the coronary arteries that supply oxygen to your heart. Your consultant will decide if this investigation is necessary.
Carotid doppler scan
This is a non-invasive test looking at potential narrowing of your head and neck arteries.
This scan will allow us to look inside the body and measure the blood vessels in your legs and to measure the size of your aortic valve. It can also assess the coronary arteries.
This is an ultrasound scan of your heart which allows the cardiac physiologist to assess the structure and function of your heart and your valves.
Lung function test
A lung function test may be required. This is a non-invasive test to assess how well your lungs are working.
Transoesophageal echocardiogram (TOE)
A TOE is a special ultrasound scan examining your heart in more detail. You will be required to attend as a day case to have this done.
These include blood tests, chest x-ray, breathing tests and ECG (heart tracing).
Your treatment options
Valvular heart disease (VHD) is present in more than half of those over 65 and this is expected to double by 2040. Many conditions require intervention and there is an increasingly wider range of therapeutic options including :open heart, minimal access, off-pump and transcatheter.
A few of your treatment options are:
- Surgical valve replacement (mechanical, bioprosthetic) plus other non-valve intervention (e.g. aorta/coronary)
- Minimally invasive valve replacement
- Transcatheter aortic valve intervention (TAVI) with advance access techniques (e.g. transcaval, subclavian)
- Transcatheter mitral edge-to-edge repair (MitraClip/Pascal)
- Transcatheter tricuspid edge-to-edge repair (TriClip)
- Transcatheter Valve-in-Valve implantation / Transcatheter Valve-in-MAC implantation
- Medical management of valvular heart disease
- Advanced diagnostics through multi-modality imaging expertise (TOE/Stress/CPEX/CT/PET-CT/DPDP/CMR).
Transcatheter aortic valve implantation (TAVI)
Aortic stenosis is a condition where the main outlet valve of the heart – ‘the aortic valve’ – becomes thickened and stiffened, preventing normal opening and causing breathlessness and heart failure.
At present this condition is generally treated with conventional aortic valve replacement (open heart) surgery.
If you need an aortic valve replacement and are not well enough to have heart valve surgery, TAVI may be the best option for you.
TAVI allows replacement of the valve with a keyhole procedure, and this is particularly useful in more elderly and frail patients.
The prosthetic valve is approximately 2cm in height and 2.5cm in width and is made of bovine pericardium (for the valve leaflets) and cobalt chromium (for the supporting stent scaffold).
We have been performing this procedure since 2008 and have established research projects comparing the clinical and quality of life benefits of conventional aortic valve surgery and TAVI.
Transcatheter mitral valve repair (TMVR)
If you are deemed too high risk for surgery, transcatheter mitral valve repair (TMVR) provides a minimally invasive option for treating the most common form of mitral valve leakage, giving new hope to our patients.
Mitral regurgitation is a condition where weakness in the heart muscle causes the mitral valve to stretch and leak. As a result of this leaking, some blood flows the wrong way and the heart has to work harder to pump this extra blood, which over time can be life threatening.
Experts at the Barts Heart Centre successfully performed the UK’s first Transcatheter Mitral Valve Repair (TMVr) procedure in 2018 with a device called a Cardioband to treat this potentially deadly condition.
The Cardioband mirrors the surgical operation in that a band is attached to the opening of the mitral valve using multiple screws and then tightened to shrink it, reducing the amount of leakage. This innovative procedure allows interventional cardiologists to reach the heart and repair the valve through a small tube, known as a catheter, which is inserted into a vein at the groin.
The procedure can be carried out in one to three hours and should result in shorter hospital stays and quicker recovery times for patients compared with those who have surgery.
Trans catheter mitral and tricuspid edge-to-edge repair (Mitraclip/Pascal/Triclip)
Mitral/ Tricuspid regurgitation is a condition in which the heart’s mitral valve does not fasten or close properly, leading to a leak or regurgitation.
The mitral and tricuspid valves are among the four heart valves that control the flow of blood in and out of the heart. If the valve becomes abnormally leaky (regurgitation), the heart must work harder to pump the same amount of blood with each heartbeat, so the work for the left ventricle (pumping chamber) increases. Without treatment, mitral or tricuspid regurgitation worsens with time. Although medicines can slow the progression of valve regurgitation, the long- term effects can result in heart failure.
Until recently, mitral valve repair has involved open-heart surgery. An alternative, less invasive form of valve repair may now be offered, Transcatheter Edge-to-Edge Repair, whereby the mitral/tricuspid valve is repaired percutaneously (“through the skin”) via the groin using a transcatheter (thin flexible tube). This method does not require any open heart surgery.
New technologies involve implanting a clip to the leaking valve. A small implanted clip is attached to your valve to help it close. The clip holds the two edges of the valve leaflets in position and reduces the extent of the leak. The end result is a valve with two openings instead of one with blood able to flow through both orifices into the left ventricle.
Our clinicians are now able to perform transcatheter mitral and tricuspid edge-to-edge repair. We have done more than 100 cases already and are continuing to expand this service to help treat more patients who need valve repairs in the most minimally invasive approach possible.
You may need surgery to stretch, repair or replace your valve. For cases of severe valve disease, surgery can greatly improve your symptoms and quality of life. The success rate is good but as with all operations, surgery carries some risk. Your age, health and the severity of valve disease will all be considered to assess whether surgery is right for you.
Your surgeon, with the wider valve team, will discuss your options with you. In the majority of cases, the surgical procedure will cure your valve problem, stopping the risk of heart failure and reducing any shortness of breath.
Surgery may be offered to you for valve repair or valve replacement. The most common treatments include:
- Mitral valve repair
- Aortic valve replacement
- Tricuspid valve repair
Valve surgery is usually performed through a cut made along the breastbone. Sometimes, it may be possible to perform the operation through a smaller cut between the ribs (keyhole valve surgery).
Another small incision may be made in the groin, for a tube (cannula) to be inserted, to control the blood flow to the heart during the operation.
Your valve surgery will be carried out under general anaesthetic – in other words, you will be asleep throughout - and will take between three and six hours.
Two main types of artificial valve are used:
- Biological (tissue) valves – made from animal tissues.
- Mechanical valves – made from metal and some carbon parts.
After your operation, you will be taken to the intensive care and high dependency units where the doctors will make sure your heart is working well, before moving you back on to the ward. Here, your recovery will be fairly swift. Most patients are ready to go home seven to ten days after their operation.
You may need to take anticoagulation drugs (warfarin) for life. These drugs reduce the risk of blood clots forming. If you need to take warfarin, you will have regular blood tests to make sure you’re on the right dose.
Your care team
Sveeta Badiani, Sanjeev Bhattacharyya, Christos Bourantas, Csilla Jozsa, Mohammed Khanji, Guy Lloyd, Ketna Patel, Thomas Treibel, Roshan Weerackody
Dincer Aktuerk, Shirish Ambekar, Wael Awad, Carmelo Di Salvo, Shyam Kolvekar, Kulvinder Lall, David Lawrence, Neil Roberts, Amir Sheikh, Rakesh Uppal, Kit Wong, John Yap
Structural interventional cardiologists
Mick Ozkor, Andreas Baumbach, Simon Kennon, Anthony Mathur, Mike Mullen
Kerry Bedford, Rhian Grieveson, Mel Jerrum, Helen Molloy, Katreena Opada
Luisa Buhayan, Marta Costa, Delfin Encarnacion, Ellie Kuysk
Emma Cheasty, Francesca Pugliese
Your outpatient appointments
Specialist valve clinic
The specialist valve clinic at St Bartholomew's Hospital runs every Friday in an integrated setup where physician and physiologist clinics run at the same time, with one-stop diagnostics (echo, ECG, BNP), as well as co-located Stress Echo, CPEX and TOE.
Structural heart clinic
The structural heart clinic runs at least twice a week and at times in conjunction with the specialist valve clinic. Patients referred to these clinics usually have a congenital or complex cardiac condition requiring input from a structural intervention specialist. Appointments will involve a consultation with one of our consultants, and are joined up with diagnostic and functional examinations, along with the full clinical examination by the cardiac specialist.
Cardiothoracic surgical clinic
The surgical clinics are varied, running at different days and times, responding to the individual needs of the patients and referrals received.
Information for professionals
Referrals can be made to:
Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE.
TAVI referrals: firstname.lastname@example.org
Mitral MDT enquiries: email@example.com
Aortic MDT enquiries: firstname.lastname@example.org
Education and research
We have a very active research programme, from improving treatments to developing new ones.
If you'd like to learn more, or get involved, please speak to your care team.