More than 40,000 Britons in need of a new heart valve are missing out on a life-saving procedure even though it has been available on the NHS for more than 15 years.
The ailing patients suffering with aortic valve stenosis, when one of the crucial valves in the heart narrows and reduces blood flow around the body, have been deemed too old or frail to survive conventional open-heart surgery.
However, a far safer and less invasive keyhole treatment – but one which is also more expensive – is rarely being offered to them.
The Mail on Sunday has discovered that only 7,000 of these procedures, called transcatheter aortic valve implantation (TAVI), are taking place every year, according to NHS data.
Charities say patients stuck on waiting lists are dying due to the backlog, which they claim is because of NHS chiefs’ refusal to allocate more funds to the procedure.
Aortic valve stenosis is usually caused by a build-up of calcium – a mineral found in the blood – on the heart valve.
The Mail on Sunday has discovered that only 7,000 of the procedures, called transcatheter aortic valve implantation (TAVI), are taking place every year, according to NHS data. Patient John Morrison (above) died aged 69 after waiting two years for a TAVI. The Gaelic football coach from County Armagh 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, replacing 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.
While this procedure is almost always safe and effective, there are risks of potentially fatal complications from the general anaesthetic, infection or heart failure during the operation.
Patients can also take several weeks or even months to fully recover.
For these reasons, aortic valve stenosis patients who are judged too old or frail are told they cannot have 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 up 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 faulty part, 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.
Patients on average spend far 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 aren’t getting it, experts warn.
‘The bottom line is there’s an under-provision of TAVI on the NHS and it’s costing lives,’ says Dr Daniel Blackman, a cardiologist at Leeds Teaching Hospitals NHS Trust. ‘Sadly, patients across the country die waiting for the procedure every month.’
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 image)
Dr Blackman, who runs a TAVI clinic in Leeds and teaches other doctors how to carry out 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 extra resources, such as more hospital space and more funding. Almost all centres which offer TAVI are in the same position.’
Heart charities claim that hospital chiefs are reluctant to allocate more funding 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 implicit costs,’ says Wil Woan, chief executive of the charity Heart Valve Voice.
‘Yes, it is more expensive than open-heart surgery, but that’s not taking into account the money ultimately saved by keeping these patients out of hospital, not to mention the fact that TAVI patients spend less time on the ward recovering, which frees up crucial bed space.’
Patient John Morrison died aged 69 after waiting two years for a TAVI. The Gaelic football coach from County Armagh was diagnosed with aortic valve stenosis in 2016.
According to his daughter, Kate Haffey, 43, doctors initially told him there was nothing to fear.
Because John had undergone a quadruple bypass 20 years earlier, doctors ruled that open-heart surgery was too risky. Instead, he was told he would get a TAVI.
‘The doctors said he could avoid an invasive procedure if he got TAVI and this would mean he’d recover quickly,’ says Kate.
But by 2018, John still did not have a date for the procedure, and his health began to deteriorate.
‘His breathing got so bad he could barely walk,’ says mother-of-three Kate, a special needs worker. ‘We kept ringing his consultant saying we were worried, but they still couldn’t say when he’d get his operation.’
Kate says the hospital told her father there was no space on the ward for him. However, in the 50 days before his death in February 2019, he was admitted to hospital five times with heart problems.
Kate says: ‘The week before he died, his consultant said he was going on holiday and that when he got back Dad might get his TAVI.’
A post-mortem examination found John died of arrhythmia – an abnormality of the heart’s rhythm – caused by aortic valve stenosis.
Kate says: ‘Dad died knowing that one procedure was all that it would have taken to save him, and he didn’t get it.’
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