How a quick operation can correct heart valve disease

Dr Dan Blackman

Interventional Cardiologist, Leeds Teaching Hospitals, NHS Trust

Mr Roger Hammond

Patient

Aortic stenosis is a potentially fatal heart valve condition which used to require open heart surgery. Now patients’ lives can be saved with a non-invasive treatment called TAVI.

When he turned 80, Roger Hammond decided to get an allotment. “I wanted to do something a bit different,” he laughs. It turned out to be a good decision – perhaps even a life-saving one, because it was then that he noticed the signs of a potentially serious heart condition. “As I was digging, I’d get breathless and have to stop what I was doing. I thought: ‘It’s my age.’”

At first, West Yorkshire-based Roger, now 85, put off going to see his GP, but finally went to his local health centre for a check-up. He returned for his results, which seemed normal. “But as I was leaving, the doctor said: ‘Roger: I’ll just listen to your heart with my stethoscope.’ And I’m glad he did because he could hear a murmur.

After further investigation, Roger was diagnosed with aortic stenosis (AS), a type of heart valve disease (HVD). “Heart valve disease is a malfunction of one of the four valves that connect the chambers in the heart and control the flow of blood,” explains Dr Dan Blackman, Interventional Cardiologist at Leeds Teaching Hospitals, NHS Trust. “Aortic stenosis is one of the most common types of HVD in adults, and occurs when the aortic valve fails to open properly.

Why you should never dismiss signs and symptoms of HVD

HVD has various causes, but is mainly due to general “wear and tear”, so predominantly affects those in later life. Symptoms can appear gradually and include breathlessness, chest pain, light headedness, or fatigue. If these occur, don’t dismiss them as ‘just what’s to be expected in old age’, warns Dr Blackman. In fact, it’s imperative to seek medical attention because any type of HVD can ultimately lead to heart failure. After the onset of symptoms, the average survival from aortic stenosis is just two years.

Thankfully, if the problem is picked up in good time and treated properly, patients can do very well. “The only treatment for all forms of heart valve disease used to be open heart surgery, which is invasive and high-risk, especially for older people,” says Dr Blackman. “Patients could expect to spend eight days in hospital with a recovery period of up to six months.” But for the past 10 or 15 years, a non-invasive keyhole valve replacement – called transcatheter aortic valve implantation (TAVI) – has been available for aortic stenosis patients. Here, an artificial replacement valve is implanted into the heart using a catheter, usually inserted via the main artery in the groin.

Roger was conscious throughout, didn’t find it painful and was discharged after an overnight stay.

A life-saving procedure that reduces the burden on the NHS

The TAVI procedure, carried out under local anaesthetic, has revolutionised life for AS patients because they are in hospital for an average of just three days, while post-op recovery usually takes a week. “This is important in the COVID-19 era when people want to minimise the amount of time they spend in hospital,” says Dr Blackman. “What’s more, because the procedure and recovery is so quick, it reduces the burden on NHS resources.”

Initially, Roger was due for his TAVI procedure at Leeds General Infirmary in March of this year; but coronavirus threw these plans into disarray. Because of lockdown the operation had to be cancelled and he was told to expect a long wait for a rescheduled appointment. “Unfortunately, my breathlessness and dizziness started to get a wee bit worse,” says Roger. “So I contacted the hospital to tell them and I was fast-tracked. Just weeks later I had the procedure.” Roger was conscious throughout, didn’t find it painful and was discharged after an overnight stay.

Life is good now. Roger especially enjoys going out for walks with his wife, Joyce. “In fact, we’ve walked every day since lockdown began, apart from when I was in hospital, obviously. We’ve already done 3,500 steps today!” The couple are also looking forward to going on holiday to Scarborough, on the North Yorkshire coast. “Unfortunately, that’s been put on hold because of coronavirus,” he says. “But when we DO get there, our aim is to get out for a long walk around the sea front – every single day.”