Experts at RB&HH Specialist Care lead the way by treating heart valve disease with transcatheter alternatives to conventional open heart surgery.
The transcatheter valve service - established at Royal Brompton and Harefield hospitals in 2007 - is delivered by a multi-disciplinary team, including surgeons, cardiologists, anaesthetists, imaging experts and specialist nurses.
Patients of all ages have access to innovative treatments, with each patient being individually assessed to ensure the best treatment path and procedure. Conventional surgery is still the gold standard treatment for aortic stenosis and mitral regurgitation. The experts at Royal Brompton and Harefield hospitals will identify what is best for the patient - surgery, or a transcatheter procedure.
The transcatheter valve team routinely carries out increasingly complex operations, with excellent outcomes. Techniques include:
- Mitral valve-in-valve and valve-in-ring implants with different devices
- Transcatheter mitral valve implantation
- Transventricular mitral neochordal implantation utilising both the NEOCHORD and HARPOON systems.
Which patients can benefit the most?
Older patients particularly benefit from the minimally-invasive heart valve procedures available at RB&HH. This is because older patients more often have co-morbidities and are considered to be at high-risk for conventional surgery.
Due to an ageing population, there is an ever-increasing number of patients requiring heart valve repair or replacement later in life. It's estimated that more than a million Brits aged over 65 are affected by heart valve disease.
What transcatheter techniques are available?
The two most common heart valve conditions - aortic stenosis and mitral regurgitation - can be treated with some novel transcatheter techniques as follows.
The aortic valve controls the blood flowing out of the heart and around the body. Aortic stenosis is the most common and serious form of valve disease. With advancing age, the valve can become progressively stiff and narrow as a result of calcium deposits, making it more difficult for blood to leave the heart. As blood flow through the valve becomes significantly reduced, symptoms can include breathlessness, chest pain, fainting and palpitations.
Our specialists run the largest programme in the UK for transcatheter aortic valve implantation (TAVI). The only effective long-term treatment for aortic stenosis is to replace the aortic valve. TAVI is a lifesaving non-surgical option for a large number of patients.
During the procedure, which can be performed under general or local anaesthetic, a catheter is guided through an artery (usually via a small incision in the groin) to the patient’s heart using special scanning equipment. A device is then placed within the narrowed aortic valve to relieve the obstruction.
At RB&HH Specialist Care, our clinical team has expertise with various TAVI devices, and considerable experience in using TAVI to treat previously implanted surgical aortic valves that are showing signs of degeneration (known as valve-in-valve TAVI).
The first transcatheter aortic valve implant took place at Royal Brompton and Harefield hospitals over ten years ago, in 2007.
The mitral valve separates the upper left heart chamber from the lower left chamber and helps control blood flow through the heart. Mitral regurgitation (MR) occurs when the valve becomes damaged and fails to close properly. This results in blood flowing backwards, or leaking, through the valve when the heart contracts.
There are a number of conditions that can lead to mitral regurgitation, but most commonly it is the valve becoming weaker over the years from 'wear and tear' or persistent high blood pressure. Symptoms can include shortness of breath, tiredness, dizziness and chest pain.
In 2014, a sixty-eight-year-old patient with mitral regurgitation became the first person in the world to have the ‘Tendyne Transcatheter Mitral Valve’ system, which was implanted at Royal Brompton Hospital.
The tissue valve replacement is placed into a patient’s beating heart without the use of cardiopulmonary bypass, commonly known as a heart-lung machine. It is implanted via a catheter through a small incision between the ribs. During the procedure, the novel device can be repositioned, removed or redeployed as necessary.
MitraClip is a transcatheter technique to treat mitral regurgitation with a less invasive approach compared to conventional surgery. RB&HH is the most experienced centre in the UK for MitraClip, having undertaken more than 230 cases (as of October 2018).
A catheter is inserted through the top of the patient’s leg and via the femoral vein, and a small hole is made to enable the catheter to cross from the right to the left side of the heart. The MitraClip device is then steered into the left atrium and is able to literally ‘clip’ the leaking portions of the valve leaflets together.
In 2016, the first patient in the UK to benefit from a new cutting-edge technique to repair a leaking mitral valve, underwent the procedure at Royal Brompton Hospital as part of a clinical trial.
The innovative minimally-invasive procedure uses a piece of equipment known as the Harpoon device, which – like a cardiac catheter – enters the heart via a small incision, until it reaches the collapsed part of the mitral valve. Once in place, the surgeon releases synthetic chords from the device which then attach to the valve. The tension on the chords is adjusted until the valve no longer leaks. The endings of the chords are then secured to the outside of the heart.
Are these treatments suitable for everyone?
For patients with MR, conventional surgery is still the gold standard treatment. Surgical members of our transcatheter valve team have international reputations in mitral surgery, particularly mitral repair.
For patients with complex mitral valve problems, the team will review each individual patient and advise which of the above procedures may be suitable. Our team can help ensure your patient is directed to the most suitable clinician for their condition.
The lead consultants for the transcatheter valve programme are:
Dr Simon Davies
Consultant interventional cardiologist
Dr Tito Kabir
Dr Robert Smith
Consultant interventional cardiologist