OBJECTIVES: Surgical replacement of heart valves were first performed in the 1960’s and until the advent of transcatheter techniques in 2007 were the only option. Anecdotal evidence suggests there is a great deal of international and “intra”-national variation in procedure numbers and we examine this variation in England to quantify the impact and likely burden of illness. METHODS:  Data up to 2015 from cardiac surgery and cardiology audits together with hospital level data were utilized together with populations statistics to define penetration of heart valve procedures. This was aligned with available data on the prevalence of heart valve disease to estimate access to therapies. We examined the most common heart valve procedures: mitral valve repair (MVRR), mitral valve replacement (MVR) and surgical aortic valve replacement (AVR) with a sub-analysis for transcatheter replacement (TAVI). RESULTS:  There was significant variation in the number of procedures across England, in 2014 for example it varied by between 6x and 16x from the best to the worst served region. For AVR there were rates between 1.8 and 30.4 per 100,000 (7,043 procedures), including TAVI this was 9940 aortic valve procedures performed in comparison with 44,727 new admissions for diagnosis of aortic valve disease. Similar geographical variation was seen for mitral valve procedures (between 1.3 and 11.8 procedures per 100,000 population, a total of 3851 surgeries) and a similar increase in the number of new admissions for mitral valve disease. Although geographic variation was evident there was no apparent link amongst different valve procedures and we graphically present the data over time together with location of treating centres. CONCLUSIONS:  The frequency and type of heart valve procedures varies widely across the UK. Total numbers are also less than seen in comparable European countries. Evidence suggests that access to therapy is non-equitably across the UK.