A new procedure to treat patients with severe heart valve disease has been carried out in a UK first at Oxford University Hospitals NHS Foundation Trust (OUH). Transcatheter Tricuspid Valve Replacement (TTVR) procedures took place at the Oxford Heart Centre, based at the John Radcliffe Hospital, in December 2023 to treat two patients with severe tricuspid regurgitation.
Tricuspid regurgitation is a disorder in which the tricuspid valve, which controls the flow of blood from the heart’s right atrium (top chamber) to the right ventricle (bottom chamber), does not close properly. Patients with this condition can have very debilitating symptoms such as fluid retention and breathlessness. It can lead to a very poor quality of life and even be life-threatening if not treated. Options for treating this condition have been very limited as open heart surgery is often prohibitively high risk and there are no effective drug treatments.
However, in a UK first, OUH has carried out the new minimally invasive procedure which has the potential to transform the care of these patients. The technology used is the first and only approved technology able to fully replace the tricuspid valve via transcatheter manner.
The leaky tricuspid valve is replaced with a new valve that can be delivered via a leg vein under a light anaesthetic, avoiding the need for open heart surgery. Patients do not need to spend time on an intensive care unit and can usually leave hospital within a couple of days.
The therapy supports many patients who previously had no treatment options, providing significant improvements in their quality-of-life.
Sam Dawkins, a Consultant Interventional Cardiologist at OUH who led on the procedure, said: “To carry out the first two procedures has been a huge step forward to provide meaningful treatment to this patient group.
“We are really excited to offer this technology safely, especially to people who have very few options and experience debilitating symptoms. It really is a breakthrough for them. We have been building up to this procedure for a long time and it has been a real team effort, including the hard work of both medical and non-medical colleagues.
“It was enjoyable for me as the operator seeing everyone pull together to make this happen. We have an enormous number of talented people here and I feel very privileged to work with them.”
He added: “We are very thankful to Edwards Lifesciences for helping us with this pioneering breakthrough treatment for patients suffering from tricuspid regurgitation, and to Oxford Hospitals Charity for funding much of the high tech equipment in our laboratory. Working in partnership has been instrumental in making TTVR at OUH a possibility.”
TTVR is now available as a treatment option for patients who have severe tricuspid regurgitation. The new procedure is now established at OUH and dozens of patients are expected to be treated each year.
Dr Andrew Brent, Chief Medical Officer at OUH, said: “We are delighted that we have been able to help these patients. It is our vision to provide the best care possible underpinned by high quality research and innovation, so we and very proud of the cardiology team who have delivered this UK first.”
‘I can be positive about the future’
Rosalind Walsh, 79 from Cheltenham, was diagnosed with tricuspid regurgitation in November 2023 following a period of illness that made her feel “absolutely terrible” and for which she required hospital care. The mother-of-two and grandmother-of-three was struggling to breathe, which was caused by a leaking valve in her heart.
Rosalind was invited to have a TTVR in Oxford and had the operation in December 2023.
She said: “I feel privileged to have undergone TTVR, which has been a miracle for me. I initially felt very tired after the operation, but I am feeling stronger and more like my old self again.
“Prior to the procedure, I felt very worried that my health problems would never go away. I was losing hope. However, I can now take on more challenges, and I am able to see a positive way forward and a much brighter future for me ahead. I think TTVR will give hope to people like me.
“I can’t praise the staff highly enough. They were very caring and kind and, although I had the expected nerves before the operation, it was very quick and I feel very happy now.”
Oxford Hospitals Charity funded over £800,000 of high tech equipment for the Oxford Heart Centre’s Cardiac Catheterisation Laboratory – or ‘Cath Labs’ – where this procedure took place. This included the very latest ultrasound equipment, which provided very high quality imaging needed to undertake this innovative procedure.
Douglas Graham, Chief Executive Officer at Oxford Hospitals Charity, said: “We are absolutely thrilled that the equipment funded thanks to the very generous support of our ‘Heartfelt Appeal’ has helped Sam and the talented team take this huge step forward.
“It is wonderful to hear of the hope this breakthrough will give so many patients who, thanks to this new procedure, can look forward to a significantly more positive future.”
Nick Walker, Senior Country Director at Edwards Lifesciences UK and Ireland, said: “Innovating for patients with unmet needs is at the centre of everything we do at Edwards Lifesciences, which makes us especially proud to have pioneered this first-of-its-kind transcatheter tricuspid valve replacement therapy.”