NHS plans to rollout keyhole surgery to more patients that will slash hospital recovery time by more than half for 300,000 Britons with deadly heart valve conditions
- The operation is designed to cure a condition called aortic valve stenosis
- Patients undergoing open heart surgery spend four more days in hospital
More Britons in need of a new heart valve will be able to have a life-saving procedure on the NHS that spares them from major surgery.
The operation is designed to cure a condition called aortic valve stenosis, which happens when a crucial valve in the heart narrows and reduces blood flow around the body.
The keyhole treatment, called transcatheter aortic valve implantation (TAVI), is safer and less invasive than conventional surgery, but more expensive. For this reason, it has been reserved for NHS patients deemed too old or frail to survive open-heart surgery.
But NHS England has announced it will ensure all aortic valve stenosis patients will have the option to get TAVI. Health chiefs believe the decision will help slash lengthy heart treatment waiting lists.
Patients who undergo open-heart surgery typically remain in hospital for seven days, while those who receive TAVI leave within just three.
The keyhole treatment, called transcatheter aortic valve implantation (TAVI), is safer and less invasive than conventional surgery, but more expensive. For this reason, it has been reserved for NHS patients deemed too old or frail to survive open-heart surgery
Patients who undergo open-heart surgery typically remain in hospital for seven days, while those who receive TAVI leave within just three
Experts believe adopting the procedure more widely will free hospital beds and staff to treat other heart patients, while charities have heralded it as a victory for patients.
‘This is a crucial step towards ensuring that valve disease patients have access to more safe and effective treatments,’ says Wil Woan, executive director of the charity Heart Valve Voice.
‘Aortic stenosis is a serious condition… we have heard many stories of people dying while waiting to be treated. This change in guidance will help increase the number of people accessing TAVI, reduce waiting times and save lives.’
Aortic valve stenosis affects more than 300,000 Britons. It is usually caused by a build-up of calcium – a mineral found in the blood – on the heart valve.
This increases with age in most people, but smoking, high blood pressure and obesity can accelerate it.
If left untreated, aortic stenosis can lead to a number of serious problems. These include heart failure – an incurable condition where the heart stops pumping blood efficiently, leading to debilitating fatigue and breathlessness.
Once it develops, many patients don’t survive for more than a year.
Replacing the faulty valve can stop heart failure from initially developing, and in most cases on the NHS this is done by open-heart surgery.
This is a major operation which involves making a deep incision in the chest to reach the heart. While almost always safe and effective, there are potentially fatal risks attached to the surgery. These include complications from the general anaesthetic, infection or heart failure during the operation. Such risks increase with age. Patients can also take weeks, or even months, to fully recover.
Instead, TAVI 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 around a deflated balloon.
When the catheter reaches the fault, the balloon is inflated, expanding the artificial valve until it is locked in place.
The technique has been shown in multiple studies to be both safe and highly effective. However, only about 7,000 of these procedures take place on the NHS every year.
Experts say this is because the cost of TAVI, estimated to be roughly £30,000 per patient, is higher than that of open-heart surgery, which costs the NHS about £18,000, causing it to be rationed by health chiefs for the most in-need.
The new NHS guidance calls for the procedure to be offered to aortic stenosis patients who are classed as having an intermediate-to-low risk of complications during open-heart surgery.
The move could allow an additional 1,500 patients to receive TAVI every year.
‘It makes total sense to offer it to more people,’ says Dr Malcolm Finlay, a consultant cardiologist at Barts Heart Centre in London.
‘This will free up surgery rooms for other, more complex heart procedures and ultimately lower pressures on the health service by reducing the time patients spend recovering in hospital beds.’
One patient set to receive TAVI under the new guidelines is Paul Haworth, 76, from West Yorkshire, who was diagnosed with aortic stenosis in 2020.
The married father-of-two, who is otherwise in good health and regularly walks for exercise, was told he would eventually need heart surgery.
‘I want to avoid staying in hospital for a week and then spend longer recovering from surgery,’ he said.
‘No one knows how long they have left so I’d rather spend more time on my feet than in bed recovering.’
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