Structural heart disease

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. 

Published research

Duncan A, Daqa A, Yeh J, Davies S, Uebing A, Quarto C, Moat M. Transcatheter Mitral Valve Replacement: Long-Term Outcomes of First-In-Man Experience with an Apically Tethered Device – A Case Series from Single Centre. EuroIntervention 2017 Aug 13. pii: EIJ-D-17-00154. doi: 10.4244/EIJ-D-17-00154. [Epub ahead of print]

Duncan A, Ludman P, Banya W, Cunningham D, Marlee D, Davies S, Kovac J, Spyt M, Moat N. Long-term Outcomes After Transcatheter Aortic Valve Implantation in High-Risk Patients With Severe Aortic Stenosis: The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. JACC Cardiovasc Interv. 2015 Apr 27;8(5):645-53.

Nienaber CA, Clough RE, Sakalihasan N, Suzuki T, Gibbs R, Mussa F, Jenkins MT, Thompson MM, Evangelista A, Yeh JS, Cheshire N, Rosendahl U, Pepper J. Aortic Dissection. Nature Reviews Disease Primers 2016; 2: 1-17.

Soo A, Mitsos S, Carnoletta M, Pepper J, DeSouza A. A single institution 16 years’ experience of aortic valve replacement using the Mosaic porcine bioprosthesis. Cardiology. Karger. 2016; 134: 245.

Pepper J. Differential aspects of the disease and treatment of Thoracic Acute Aortic Dissection (TAAD) – the European experience. Ann.Cardiothorac.Surg. 2016; 5(4): 360-367.

Nienaber CA, Sakalihasan N, Clough RE, Aboukoura M, Mancuso E, Yeh JS, Defraigne JO, Cheshire N, Rosendahl UP, Quarto C, Pepper J.  Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?  J.Thorac.Cardiovasc.Surg. 2016 (Aug 29) doi.10.10.1016/j.jctvs.2016.07.078.