Heart valve disease surgery has a long history. In the 1940s, a procedure to widen a stiffened mitral valve was one of the very first types of heart surgery to be commonly performed.
Back then, heart valve disease – which disrupts the essential one-way flow of blood through our hearts – was often the result of rheumatic fever. Today, aging, infection, and other heart conditions, mean heart valve disease is still a common problem.
Thousands of people in the UK have heart valve replacement each year, and many benefit from the research and advances made possible by the BHF.
Finding the perfect material to replace patients’ diseased or defective heart valves is a challenge that remains today. The first mechanical valves were made of metal, but in the early 1960s, Donald Ross performed the first ‘homograft’ replacement at Guy’s Hospital, which replaced the patient’s diseased aortic valve with a preserved human heart valve.
Sadly, 22 of the first 31 patients died after the procedure, so the BHF awarded Donald Ross one of our first research grants to review all his cases and improve safety. This led to a change in the surgical technique, and made a monumental improvement in the survival rates for patients who received valve replacements- from 29% to 85%.
We awarded Ross several more BHF grants, and he went on to develop a procedure for aortic valve replacement known as the ‘Ross Procedure’. In Ross’s groundbreaking technique the patient’s faulty aortic valve is replaced by their own pulmonary valve, which is replaced with a donated valve . It’s still used by surgeons, especially for treating infants and children born with heart defects.
In the same decade as Ross’s early work, surgeons were also beginning to experiment with valve transplants from other species. This began with heart valves from pigs and then, in 1970, BHF funding helped Marian Ionescu at Leeds General Infirmary engineer a prosthetic valve from cow heart tissue. Replacement heart valves created from bovine tissue are still used today.
Choosing the right valve replacement
BHF-sponsored researchers led the collection of data about the safety and performance of mechanical and biological replacement heart valves. This provides evidence to help doctors and patients decide on the type of valve that will suit them best.
Two big studies that kept track of people with valve replacements were the Edinburgh Heart Valve Study and the UK Heart Valve Registry. They were set up by former BHF Professors David Wheatley and Ken Taylor, respectively.
Advances in medical engineering since the turn of the millennium mean replacing heart valves doesn’t always require open heart surgery. Sometimes it can be done using a catheter fed through the artery from an incision in the patient’s groin - a procedure called percutaneous valve replacement.
Percutaneous procedures are less risky and invasive for the patient, and are quicker to recover from. So they’re particularly good for the very elderly and for children born with heart problems, who may need repeat procedures as they grow. That’s why, in 2007, the BHF helped to fund a high-tech catheter lab at Great Ormond Street Hospital to help guide percutaneous valve replacements in young patients with complex heart conditions.
Still more to do
Heart valve disease can develop for a long time without any symptoms. By the time the patient is diagnosed, their heart may already be damaged. We’re funding research to improve the early diagnosis of valve disease, and spot the people who would benefit most from early interventions.
Today’s mechanical heart valves are made of super-smooth carbon and will last a lifetime. However, patients who receive a mechanical valve have to take lifelong anticoagulant medication, to prevent blood clots forming around the device. This carries a risk of internal bleeding, so we’re funding research to develop the next generation of heart valves that are long-lasting and avoid the need for anticoagulants.
Despite decades of advances, the physical repair or replacement of diseased heart valves is still the only effective treatment. We fund research to understand the basic science of valve disease, towards finding a medicine that can stop it in its tracks and avoid the need for surgery.