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More than 40,000 Brits in need of a new heart valve are missing out on a life-saving procedure, despite it having been available on the NHS for more than 15 years.
The sick patients, who suffer from aortic stenosis, when one of the crucial valves in the heart narrows and reduces blood flow through the body, are considered too old or frail to survive traditional open-heart surgery.
However, a far safer and less invasive keyhole treatment – but one that is also more expensive – is rarely offered to them.
The Mail on Sunday has found that only 7,000 of these procedures, called transcatheter aortic valve implantation (TAVI), take place each year, according to NHS data.
Charities say patients stuck on waiting lists are dying because of the backlog, which they say is due to NHS bosses' refusal to allocate more funding to the procedure.
Aortic valve stenosis is usually caused by a buildup of calcium - a mineral found in the blood - on the heart valve.
The Mail on Sunday has found that only 7,000 of the procedures, known as transcatheter aortic valve implantation (TAVI), take place each year, according to NHS data. Patient John Morrison (above) died at the age of 69 after waiting two years for a TAVR. The County Armagh Gaelic football coach was diagnosed with aortic stenosis in 2016
This naturally increases 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 Brits, can lead to a range of serious conditions, including heart failure.
For the majority of patients, replacing the defective valve is the only effective option, and in the past this has been done through open heart surgery - a major operation in which a deep incision is made in the chest to reach the heart.
While this procedure is almost always safe and effective, there is a risk of potentially fatal complications from general anesthesia, infection, or heart failure during surgery.
It can also take patients several weeks or even months to fully recover.
For these reasons, patients with aortic valve stenosis who are judged to be too old or frail are told that they cannot undergo open heart surgery.
More than 50,000 Brits fall into this category, according to a study by the University of Notre Dame in Australia that examined British health data.
TAVR, first performed on the NHS in 2007, 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 from 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 locks into place.
The technique has been proven to be safe and highly effective in multiple studies.
Patients, on average, spend much less time recovering in the hospital than patients undergoing open-heart surgery and are less likely to experience complications. But those who need the surgery aren't getting it, experts warn.
“The bottom line is that there is an under-provision of TAVI in the NHS and it is costing lives,” says Dr. Daniel Blackman, cardiologist at Leeds Teaching Hospitals NHS Trust. “Unfortunately, patients across the country die every month while waiting for procedures.”
If left untreated, aortic valve stenosis, which affects more than 300,000 Brits, can lead to a range 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 TAVI three days a week and we could do four or even five,” he says. "We need additional resources, such as more hospital space and more funding. Almost all centers offering TAVI are in the same position."
Heart charities claim hospital bosses 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 doesn't take into account the money that will ultimately be saved by keeping these patients out of the hospital, not to mention the fact that TAVR patients spend less time in the ward recovering, resulting in more crucial sleep space."
Patient John Morrison died at the age of 69 after waiting two years for a TAVR. The County Armagh Gaelic football coach was diagnosed with aortic stenosis in 2016.
According to his daughter Kate Haffey, 43, doctors initially told him there was nothing to worry about.
Because John had undergone a quadruple bypass 20 years ago, doctors decided that open-heart surgery was too risky. Instead, he was told he would get a TAVI.
“The doctors said he could avoid invasive surgery if he got TAVI and that would mean he would 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 became so bad he could barely walk,” said mother-of-three Kate, a special needs worker. “We kept calling his consultant and saying we were worried, but they still couldn’t say when he would have surgery.”
Kate says the hospital told her father there was no room for him on the ward. However, in the 50 days before his death in February 2019, he was hospitalized five times with heart problems.
Kate says: "The week before he died his consultant said he was going on holiday and when he came back Dad might have his TAVI."
A post-mortem revealed John died of arrhythmia - an abnormality in the heart's rhythm - caused by aortic valve stenosis.
Kate says: "Dad died knowing that one procedure would be enough to save him, and he didn't understand it."