Aortic stenosis: Sheffield doctors warn of killer many don't know they have as surgery landmark approaches

But Sheffield hospital doctors have now stepped up the battle against a potentially deadly narrowing of the arteries with a new type of surgery that takes away some of the risk in older patients.

Doctors believe there may be many people living with the condition, known as aortic stenosis, without knowing it. But a treatment at the Northern General which is about to mark its 500th patient is offering quick operations that avoid the need for open heart surgery and allow the patient to go home without a long hospital stay.

A recent UK wide study published in Open Heart involving cardiologists from Sheffield Teaching Hospitals NHS Foundation Trust showed that around 300,000 people in the UK are estimated to be living with aortic valve stenosis, a severe and potentially fatal disease, which occurs when the valve between the lower left heart chamber and the body’s main artery becomes narrowed and constricted.

Death rate

Dr Muhammad Rahman, interventional cardiologist at Sheffield Teaching Hospitals, said the death rate from aortic valve stenosis was worse than some cancers – and people should be aware of the symptoms.

He said the symptoms were breathlessness, chest pain on exertion, dizziness and blackouts.

“We need to increase awareness of this,” he said. “There are thought to be around 100,000 patients who have not been diagnosed.”

He is part of the team that carries out new operations called TAVI – short for transcatheter aortic valve implantation, which is being led by cardiologists and nurse specialists from Sheffield Teaching Hospitals, and enables patients aged 75 and over to have heart valves replaced without the need for a general anaesthetic. Heart specialists say it could transform outcomes for elderly patients living with severe aortic stenosis whose advancing age, multiple health problems and frailty often mean they are unable to have conventional open-heart surgery.

Heart valve

He said: “TAVI is a relatively newer advancement in heart valve replacement treatments so we don’t yet know how the long-term benefits compare to open-heart surgery beyond 10 years, but what we do know is that if a TAVI is given to elderly patients, it can add another 10 to 15 quality years to their life whereas if we don’t treat it, patients are unlikely to survive for more than one-two years.

“The development of this service is great news for elderly patients with severe aortic stenosis, as we can potentially change the trajectory of their lives through ‘lighttouch’ TAVI.”

Dr Kenneth Morgan, consultant cardiologist at the trust, added: “Aortic stenosis is a common and severe condition, which we believe is far more prevalent than currently recognised as symptoms only appear when the condition is at its most advanced – and potentially most fatal – stage, so we are delighted to launch this new streamlined service.”

To carry out the new type of operation cardiologists first make a small incision in the top of the leg to guide a small tube known as a catheter through to the arteries and into the heart.

The new valve can then be positioned on top of the existing faulty valve which is simply pushed aside.

Shorter recovery

For elderly patients, having TAVI under light sedation has been shown to have many benefits. This includes reducing their risk of serious complications from having a general anaesthetic and a shorter post-operative recovery time compared to open-heart surgery. Patients undergoing TAVI typically go home two to three days after their procedure and have a shorter recovery period.

The TAVI service at Sheffield Teaching Hospitals has been in place since 2017, and is currently led by Dr Javaid Iqbal. The team comprises of interventional cardiologists including Dr Iqbal, Dr Morgan and Dr Rahman and a senior nurse specialist, Melanie Neville. Patients suitable to undergo TAVI are assessed and reviewed by a multi- disciplinary team, to help decide if it is the best option.

Dr Rahman said the work of the team was now getting back to its normal levels, after it was temporarily affected by the pandemic. He added that so far, since it was set up, the team had treated around 490 operations. He said he expected them hit hit the landmark 500 shortly

One patient who has been treated is John Stoner. John told how he had a new heart valve fitted less than two weeks before his 90th birthday, and was able to attend his own party.

‘I was getting breathless’

John, who underwent a ‘light touch’ TAVI in May, said: “I’ve always been fit and well, but I was getting breathless climbing hills and it was rapidly becoming concerning.”

Avid golfer, John, retired for 32 years, continued to remain active, but started to worry when he noticed he could no longer putt as many golf balls as he used to. A trip to his GP led to a diagnosis for the most advanced form of aortic stenosis, and he was referred to the TAVI specialist team at Sheffield Teaching Hospitals.

After his operation, he said: “I still can’t believe how painless it all was. I could feel the difference straight away. I’m nearly 90, but an extension to my life, at my age means a lot. I’ve been pretty lucky all my life, so the outcome of this, it’s just the icing on the cake.”

John was able to return home the next day following his ‘light touch’ TAVI, and spent his milestone birthday surrounded by his family.