Structural heart disease covers a number of defects which affect the valves and chambers of the heart and the aorta. Some defects are present at birth (congenital) while others form later in life.
Research areas
The aorta and aortic valve
- Identifying new genes and understanding the genetic mechanisms responsible for structural changes in aortic wall and bicuspid aortic valves.
- Identifying genetic and biological markers to help develop early diagnosis and treatments for parents with abnormal aortas and their relatives.
- Assessing effectiveness of a preventative aortic operation developed at the hospitals for patients with inherited Marfan syndrome.
- Running an international therapeutic drug trial to target restoring the structure of the aortic wall.
Transcatheter Aortic Valve Disease
Royal Brompton Hospital is one of the busiest centres in the UK for transcatheter aortic valve implantation (TAVI), an alternative intervention to surgical replacement of the aortic valve for severe aortic stenosis. We are a leading centre in TAVI procedures for patients who have previously undergone surgical aortic valve implantation (Valve-in-Valve TAVI).
Current areas for research include:
- The five-year outcome following TAVI vs conventional surgery.
- The five-year outcome of Valve-in-Valve TAVI.
- The use of BNP to predict outcome.
- The prediction of patients requiring pacemaker implantation.
Transcatheter Mitral Valve Disease
Mitral valve pathology is heterogeneous and while several pathologies are responsive to successful sugical interventions, there are a small number of prohibitively high-risk patients who are unable to benefit from these interventions. At Royal Brompton Hospital, we are developing three major routes of transcatheter mitral valve interventions using:
- Devices designed originally for the aortic position but adapted and used in the mitral position (examples include valve-in-ring (ViR) implantations of the transcatheter "aortic" valve in a failing mitral bioprostheis or failed surgical mitral valve repair).
- Devices designed specifically for the mitral valve (Transcatheter Mitral Valve Replacement) and include the Abbott Tendyne TMVI, Edwards CardiaQ, Medtronic Intrepid and the Neovasc Tiara valves, which have active clinical programs under protocol.
- Implantation of transventricular neochorde for the treatment of degenerative mitral valve disease. Expanded Polytetraflouroethylene neochordae are implanted transapically through a small apical thoracotomy on to the prolapsing segment of the mitral valve leaflet. Chordal length is titrated under 2D and 3D TOE guidance on the beating heart, to achieve optimal coaptation and resultant abolition of the regurgitation jet. The two devices on the market, the Harpoon and the NeoChord are both showing promising results, although the longevity of the mitral valve repair remains to be established.