Narrowing, or stenosis, of the aortic valve is one of the most common heart problems faced by older people, with an estimated 4% of those aged over 65 affected. The solution is replacement of the valve, requiring open-heart surgery. For the patients at Middelheim, that was no longer an option, given their age and condition. Instead, the surgeons decided to implant the so-called percutaneous aortic valve (PAV), which is brought into the heart through an artery after being introduced through a simple puncture in an artery in the groin.

The normal valve used in open heart surgery that is reimbursed by the government costs between €1,700 and €2,000, whereas the PAV costs €20,000. In the rest of Europe, the cost would be covered by national insurance schemes, but in Belgium (and the US) it is not. The federal Knowledge Centre for Health Care (KCE) considers the treatment unproven: in France, nearly one in four patients died within six months of the procedure, a spokesman said, and one in eight within a month. In the case of the Middelheim patients, the PAV was a last resort, doctors admitted.

“It’s only logical that we should pay for valves ourselves sometimes,” commented Middelheim cardiologist Glenn Van Langenhove. “Not everyone has that much money, and we can hardly send people away to die.”