The NHS ‘denies’ thousands of keyhole operations on heart patients that could change their lives and reduce their risk of death

By Liam On May 26, 2024

Thousands of patients with a common heart problem that leaves them weak and struggling to breathe are being denied a quick keyhole operation that could change their lives and reduce the risk of death.

A potentially fatal condition called mitral regurgitation (MR) affects around one in fifty people and is caused by a leaky heart valve. Patients may even become exhausted from daily activities such as showering or dressing.

Open heart surgery can solve the problem, but is often considered too risky. But now surgeons have developed a keyhole procedure which they believe could treat thousands more MR patients – but say it is being blocked by the NHS.

The remarkable surgery, called transcatheter edge-to-edge repair (TEER), inserts a thin tube, called a catheter, into a vein in the patient’s groin to insert a small clamp – like a clothespin – into the heart. conduct.

Clipping off the faulty valve can reduce the leak and restore normal heart function, dramatically improving quality of life, even for critically ill patients. The procedure takes two hours, has minimal recovery time and, because it is less invasive, there are fewer complications.

The remarkable surgery, called transcatheter edge-to-edge repair (TEER), inserts a thin tube, called a catheter, into a vein in the patient’s groin to insert a small clip – like a clothespin – into the heart. conduct

A potentially fatal condition called mitral regurgitation (MR) affects around one in 50 people and is caused by a leaky heart valve. Patients can even become exhausted from daily activities such as showering or dressing (stock image)

But at a cost of around £30,000 per patient, around double the cost of open-heart surgery, the NHS has only approved the relatively new procedure for a limited category of patients. That’s why campaigners are urging the company to change the rules to make it more widely available.

WHAT IS A NICE MITRAL VALVE?

The mitral valve is a small flap in the heart that prevents blood from flowing in the wrong direction. If it is damaged, it can affect the way blood flows through the body.

A ‘leaky’ mitral valve is the nickname for a condition called mitral regurgitation, in which the valve does not close well enough and blood flows in the wrong direction.

This puts a strain on the heart and often causes symptoms such as shortness of breath and fatigue. Harvard Medical School states.

In the long term, mitral regurgitation can lead to serious complications such as atrial fibrillation (an irregular heartbeat) and heart failure.

It is often caused by mitral valve prolapse, when the flaps – called leaflets – bulge back into the left atrium as the heart contracts.

However, a leaky mitral valve can also develop over the years, as a result of general ‘wear and tear’ of the valve NHS say.

Other causes include cardiomyopathy (stiff heart chamber muscles), an infection of the inner lining of the heart or congenital heart disease.

Statistics show that the NHS carries out around 2,200 mitral valve repairs every year.

Dr. Jonathan Byrne, a consultant cardiologist at King’s College London and head of the Valve For Life group in Britain, which aims to expand access to keyhole therapies for people with heart valve disease, warned that too many patients were continuing to suffer.

He said: ‘A large number of patients have been excluded from this routine, safe and effective treatment. They continue to struggle with debilitating symptoms. They will need to see their GP regularly. Many walk in and out of A&E. Some will even die.

“It’s very frustrating because TEER is actually very simple, even for a patient who is very sick.”

For 44-year-old Nicolae Olifirenco, TEER gave him his life back after a heart attack. He was rushed to hospital in the middle of the night and diagnosed with severe heart failure and a leaking mitral valve.

Unlike a heart attack, which occurs due to a blockage in the circulatory system, heart failure is a fatal long-term condition in which the muscle does not pump as well as it should, causing not enough oxygen-rich blood to flow through the body, resulting in debilitating symptoms . .

Mr Olifirenco struggled to breathe, was bedridden and so weak he could not wash or even change his pajamas without help. After a month in intensive care, he was warned he might need a heart transplant.

Although not technically eligible for TEER, the NHS decided to make an exception and offer him the procedure due to the severity of his condition.

Last month, Dr. Byrne performed the procedure, which allowed Mr. Olifirenco to return home and resume his normal life.

Mr Olifirenco, a Ukrainian living in London, said: ‘The day I had a heart attack, I woke up at 1am with severe pain in my chest and left arm. I couldn’t breathe properly. My blood pressure was so high and my body was swollen – my legs, arms, face.

‘I needed 24-hour supervision and I couldn’t even walk.

But at a cost of around £30,000 per patient, around double the cost of open heart surgery, the NHS has only approved the relatively new procedure for a limited category of patients (stock image)

‘I had a very leaky heart valve and suffered from severe heart failure. I was in intensive care for about a month.

‘I felt so ill that the team considered an urgent heart transplant. I was terrified. I never thought I would leave the hospital.

‘Luckily my doctor was able to offer the keyhole mitral TEER procedure and I have made a full recovery.’

The mitral valve is a small flap in the heart that ensures that blood only flows in one direction. Mitral regurgitation occurs when the valve does not close properly, causing blood to flow in the wrong direction.

MR affects about two percent of the population, although most are treated with medications rather than surgery. The condition is more common in older people. One variant – degenerative MR (DMR) – occurs when the valve leaks due to wear and tear. Another, called functional MR (FMR), occurs when the valve doesn’t work due to another condition or problem, such as a heart attack or heart failure.

MR affects about two percent of the population, although most are treated with medications rather than surgery. The condition is more common in older people (stock photo)

Until recently, severe MI could only be resolved by repairing or replacing the mitral valve through open-heart surgery. However, for some patients, such a major operation is too risky. Surgeons also found that while open heart surgery is good for treating patients with DMR, it is less effective and riskier for patients with FMR.

TEER, on the other hand, works for patients with both MR variants and can be used even where open heart surgery would not be suitable. But in 2019 the NHS stated that TEER could only be used for patients with DMR – around 500 per year.

Doctors believe it could also be offered to about 3,000 FMR patients per year.

Professor Dan Blackman, chairman of the British Cardiovascular Intervention Society Structural Heart Group, also believes it should be more widely available. He said: ‘TEER is standard in other countries, but we have the lowest rate in Europe. I hope the NHS will reconsider its views.”

Last week, NHS England said it will look again at the use of TEER for patients with FMR.

A spokesperson said: ‘NHS England is committed to providing safe and effective treatments for patients from all clinical specialties in a fair and equitable way.’