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Cardiovascular Health 2019

Innovations are transforming heart valve disease treatment

iStock / Getty Images Plus / Robert Daly

Mr Christopher Young

Consultant Cardiovascular Surgeon, St Thomas’ Hospital, London,
Chair of Heart Valve Voice

Innovations in heart valve technology and implantation systems are set to transform the lives of more people with heart valve disease.

Heart valve disease is a common condition that can turn into a killer

Half of UK over-65s have some level of disease related to heart structure. Over one in 10 – around 1.5 million people – have moderate or severe disease. By 2040, this is expected to reach 2.7 million.

Statistics show that, of those with the most common heart valve disease, severe aortic stenosis, half will die within two years and only 3% survive five years.

Part of the problem is detection. Chris Young, the heart surgeon and chair of the charity, Heart Valve Voice (HVV), says: “The main symptoms are breathlessness and feeling tired, but many people attribute this to age.”

Once suspected, heart valve disease can be diagnosed by listening to the heart through a stethoscope – but only 7% of UK GP consultations include this (compared to 79% in France).

Treatment in less severe conditions usually starts with monitoring. “Monitoring means we can predict when valve repair is needed,” says Young. Traditionally, this required open heart surgery, but new techniques are making this faster, easier and safer.

Treatment innovations use tissue from cow or pig hearts

Innovative heart valves have recently been tested in the UK TAVI Trial. The valves, made of tissue taken from cow or pig hearts, are used to repair the patient’s damaged aortic valve, using transcatheter aortic valve implantation (TAVI).

The valve is threaded into the body, usually via the femoral artery, until it reaches the patient’s own aortic valve, where it takes over the task of pumping blood.

Catheterisation typically takes one to two hours and the typical hospital stay is three to five days. Procedure time, days in hospital and the risk of complications are lower than with traditional open heart surgery.

Young says: “The TAVI trial will deliver more information about valve performance and patient outcomes. TAVI is underused in the NHS at present but I expect it to become mainstream in the next few years.”

A new lease of life

Heart valve repairs can deliver dramatic new energy and lengthen patients’ lives.

“Typically, those who have successful surgery go on to live longer than their peers who have had no heart valve problems,” says Young. The effort of pushing blood through an abnormal valve makes the heart stronger, so once the problem is corrected the heart is more efficient than average, he explains.

I’ve seen people who, before surgery, were only able to walk slowly, transformed into people who can achieve more than they ever could before.

More and better treatment

Inequalities of diagnosis and under-treatment of heart valve disease has spurred HVV to work with valve care specialists and patients to create Gold Standard of Care Guidelines. “These will help optimise patient care, improve access and influence policy makers on behalf of heart valve disease patients,” says Young.

HVV is now helping develop the 2019 NICE heart valve disease guidelines, and the issue will be debated in Parliament soon.

Meanwhile, Young counsels: “Ask for a stethoscope check. Undetected heart valve disease can kill.”

To find out more about heart valve disease, read more on Heart Valve Voice

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