Timing of heart surgery crucial, research shows

Published by  News archive

On 18th May 2022

Surgeons perform heart surgery in an operating theatre.
Getty images

Valve replacement heart surgery should be performed earlier than conventionally thought for people with aortic stenosis – according to new research from the University of East Anglia.


The condition is one of the most common and serious valve disease problems, caused by a narrowing of the aortic valve opening.

Once patients develop symptoms such as breathlessness, chest pains or blackouts then guidelines recommend replacing the narrowed valve.

But many patients with aortic stenosis do not have symptoms even when they have severe narrowing of the valve and are thus not eligible for valve replacement.

New research published today shows that these patients would benefit by undergoing a valve replacement – before they suffer irreversible heart muscle damage.

Lead researcher Prof Vassilios Vassiliou, from UEA’s Norwich Medical School, said: “The heart has four valves, which allow the blood to flow in one direction efficiently. With increasing age, one of the valves, the aortic valve, becomes increasingly narrowed or ‘stenosed’.

“A lot of patients with severe aortic stenosis do not have symptoms and therefore are not eligible for valve replacement according to the current guidelines.

“For these patients without symptoms, the guidelines suggest a ‘watchful waiting’ approach and intervention is recommended only when they show symptoms or develop pump failure.

“We wanted to know if it would be better to perform surgery and replace the valve sooner rather than later.”

The research team carried out a systematic review and meta-analysis, comparing early intervention versus conservative management in patients with asymptomatic severe aortic stenosis.

They then analysed data from all the available studies which involved a total of 3,798 patients, out of which 302 were included in the two largest randomised controlled trials and 3,496 in the observational studies.

Prof Vassiliou said: “We found that early intervention, before patients have symptoms, is associated with lower risk of death and hospitalisation for heart failure.

“By the time the patients develop symptoms, there has likely been irreversible damage to the muscle of the heart. This in turn may preclude a worse prognosis and adverse outcomes even after successful intervention.

“The timing of aortic valve intervention is crucial.

“We hope that our findings may herald the beginning of a change in the management of aortic stenosis patients, enabling the intervention to take place more commonly whilst the patients are asymptomatic. 

“Ongoing trials investigating this high-risk population are anticipated to shed more light into the matter and in the identification of the optimal time of intervention,” he added.

The research was carried out in collaboration with the University of Cambridge, the University of Edinburgh, the Norfolk and Norwich University Hospital, West Suffolk Hospital, the Royal Brompton and Harefield Hospitals, Imperial College London, and the University of Leicester. It was partly funded by the Wellcome Trust.

‘Management of asymptomatic severe aortic stenosis: A systematic review and meta-analysis’ is published in the journal Heart Open on May 18, 2022.

Latest News

 
Two panels of the climate change mural artwork
25 Nov 2022

Climate change mural now on display at Norwich City Hall in historic year for Climatic Research Unit

On the 50th anniversary year of UEA’s Climatic Research Unit (CRU), the stark impact of climate change has been brought into focus by a giant mural now on...

Read more >
 
25 Nov 2022

Subsidence control reduces flood risk in China’s coastal communities in China

New research suggests that implementation of a national policy of subsidence control would greatly reduce the impacts on sea level rise for people living in...

Read more >
 
Chimneys with smoke
23 Nov 2022

UEA receives share of £5 million investment

UEA is part of a UK research consortium led by the National Physical Laboratory (NPL) to receive £5 million investment to grow national greenhouse gas...

Read more >
 
UEA Climbing club before and after shaving their heads for charity fundraiser
23 Nov 2022

UEA Climbing club members brave the shave in solidarity with president’s alopecia diagnosis

On Wednesday 26 October, UEA Climbing president Nina Hatton-Perkins and her club members ran a head-shaving fundraiser for Alopecia UK, a small national charity...

Read more >
Are you searching for something?
 
UEA Climbing club before and after shaving their heads for charity fundraiser
23 Nov 2022

UEA Climbing club members brave the shave in solidarity with president’s alopecia diagnosis

On Wednesday 26 October, UEA Climbing president Nina Hatton-Perkins and her club members ran a head-shaving fundraiser for Alopecia UK, a small national charity...

Read more >
 
An elderly couple dancing.
21 Nov 2022

£2.6 million to fund largest ever study into social prescribing for dementia

Researchers at the University of East Anglia will investigate how social prescribing could be used in promoting a higher quality of life for people living with...

Read more >
 
Icebergs melting in the Atlantic
18 Nov 2022

Climate change driving changes of plankton in our ocean

Scientists have discovered that the heating up of the North Atlantic is causing plankton to shift and change in abundance, indicating a threat to the earth’s...

Read more >
 
Degree Apprenticeship programme team with their prize
01 Nov 2022

Clinical Associate in Psychology training wins national award

The national development of the Clinical Associate in Psychology degree apprenticeship, which UEA has played a key part in establishing, has won the Workforce...

Read more >
 
Chemical molecules
01 Nov 2022

UEA researchers uncover how ancient protein-bound iron cofactors are assembled in bacteria

Mass spectrometric studies of the assembly of an essential and common iron- and sulfur-containing cofactor has revealed a ‘sulfur first’ mechanism.

Read more >