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).
Structural interventions
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.
Cardiac surgery
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.
