Fixing the heart valve: The roll-out of a life-changing procedure in New Zealand

While Transcatheter Edge-to-Edge Repair (TEER) is proven to be lifesaving for high-risk patients with mitral valve disease, New Zealand’s rollout remains slow, uneven, and underfunded.

Regional disparities, workforce shortages, and lack of national coordination mean many patients — particularly elderly and Māori or Pacific populations — still face barriers to this minimally invasive treatment.

Expanding TEER access requires investment, national planning, and equity-focused strategies to prevent unnecessary suffering and deaths.

For patients who are eligible but unable to access TEER, the consequences are immediate.

Delayed or absent treatment can mean repeated hospitalisations, worsening heart failure, and, in some cases, no viable intervention at all.

In practice, access is shaped by restrictive funding, workforce pressures, and where services are available.

Heart valve disease is increasingly common in Aotearoa.

As our population ages and cardiovascular disease rates remain high, conditions such as mitral regurgitation — where the mitral valve leaks and forces the heart to work harder — pose a serious threat to patients’ health.

Left untreated, it can lead to heart failure, repeated hospitalisations, and premature death.

Traditionally, open-heart surgery has been the standard treatment, but many older or frail patients are considered too high-risk for such invasive procedures.

TEER offers a minimally invasive alternative.

By repairing the valve through a catheter rather than opening the chest, it reduces surgical risk and shortens recovery, often allowing patients to leave hospital within a day or two.

Globally, it has become a routine procedure for high-risk patients.

But in New Zealand, access is still limited and inconsistent.

TEER is performed via a catheter inserted through the femoral vein.

A specialised clip attaches to the valve leaflets, reducing leakage and restoring more normal blood flow — all without stopping the heart.

TEER preserves the patient’s native valve rather than replacing it, enabling faster rehabilitation and fewer complications.

For patients previously deemed too high-risk for open-heart surgery, TEER can be transformative.

It allows patients to maintain a higher quality of life, avoid long ICU stays, and recover more quickly than with traditional surgery.

Despite its clinical value, TEER has not been widely adopted in New Zealand’s public health system.

Dr Andrew Chatfield, Coronary and Structural Interventional Cardiologist and member of the Kia Manawanui – The Heart of Aotearoa (now Cardiac and Respiratory Foundation NZ) Cardiac Advisory Board, says progress is being made, but slowly and without a clear national plan.

“Progress is happening but in fragments: it’s very slow and it’s sort of happening piecemeal rather than a big, clear national approval to treat your patients, but I'm positive about it happening — eventually — in New Zealand.”

While most major centres now offer the procedure, Wellington has yet to fully implement it.

“In the TEER space, we are lagging a long way behind — particularly Wellington, which is a shame,” Dr Chatfield says.

Currently, patients in regions without TEER must travel long distances for treatment or wait indefinitely for local services to start.

Funding is also a major barrier.

TEER is approved by Health NZ Te Whatu Ora but is not yet publicly funded through Pharmac.

“Privately, only a small number of people in New Zealand are able to pay out of pocket in full, which highlights some inequality,” Dr Chatfield says.

“Not many can afford to do this, leaving many others without that option.”

The lack of funding and regional access means that patients who could benefit most from TEER are left with either high-risk surgery or no treatment at all, he says.

“Some of these leaky valves that could be fixed with TEER, particularly in patients with other cardiovascular and non-cardiovascular risks, could avoid higher-risk surgery.

“Without access, some may not be getting any treatment at all,” Dr Chatfield says.

“If TEER remains inconsistently available, existing cardiovascular inequities risk widening rather than narrowing.”

Access is also constrained by workforce shortages and stretched hospital resources.

New Zealand currently has only a third of the cardiologists it should have, and many hospitals operate under capacity pressures.

“We are operating within a stretched and stressed healthcare environment,” Dr Chatfield says.

“Supporting additional resources such as sonographers,nurse coordinators, extra beds, and nursing staff will help ease the workload and improve patient recovery.”

These challenges mean that even when TEER devices are available, hospitals may not have the capacity to perform procedures for all eligible patients, particularly in smaller or under-resourced regions, he says.

Experts emphasise thatexpanding TEER access is not only clinically important — it’s economically rational.

Delays in treatment lead to repeated hospitalisations, ambulance transfers, and extended rehabilitation, costing the healthcare system far more than the procedure itself,” Dr Chatfield says.

“Supporting TEER isn’t just a compassionate choice — it makes financial sense.

“The cost of repeated hospital stays, ambulance trips, and long recoveries far outweighs the cost of the procedure itself.”

Investing in TEER would allow hospitals to treat high-risk patients more efficiently, reduce strain on intensive care units, and improve outcomes for patients who might otherwise be ineligible for treatment, he says.

Unequal access to TEER risks worsening existing health disparities.

Māori and Pacific people in New Zealand develop and die from cardiovascular disease significantly earlier than other populations.

Without equitable rollout of minimally-invasive procedures like TEER, vulnerable populations may continue to miss out on treatment that could prevent high-risk surgery or death.

Dr Chatfield is involved in initiatives to track TEER outcomes, waitlists, and equity metrics nationwide.

He believes a national structural heart registry would help provide visibility into who is receiving TEER, where procedures are being performed, and where gaps in access remain.

Infrastructure improvements may also help expand services in regions currently unable to provide the procedure, he says.

Wellington Hospital, for example, is expected to receive a second cardiac catheterisation laboratory later this year.

“Once the labs are fully up and operational, I don’t see a strong reason why TEER can’t be done in Wellington,” Dr Chatfield says.

Establishing national coordination, alongside investment in staffing and infrastructure, could help bring New Zealand in line with countries such as Australia and the UK, where TEER is widely available for high-risk patients.

As the population ages, more people will require timely interventions for mitral valve and other structural heart diseases.

TEER offers a minimally invasive, life-saving option for those who would otherwise be denied treatment due to risk factors or geography.

But unless New Zealand addresses funding, workforce, and equity barriers, patients will continue to face unnecessary delays and uneven access.

“We have the technology, we have the expertise, and we have patients who desperately need it,” Dr Chatfield says.

“What’s missing is a system ready and willing to deliver it to everyone who could benefit.”