The UK needs to prepare for an epidemic of valvular heart disease, caused by a rapidly ageing population, say experts.
With four million people set to be aged 75 to 84 within a few years, surgeons see a rise in the number of transplants to replace worn out valves.
Latest audit data shows a sharp increase in all types of valve surgery in the UK, with some surgeons say it is now taking up 40% of their workload.
Experts say the UK is poorly prepared for more cases.
European and US data indicate that more than 13% of people aged 75 and above have valvular heart disease (VHD).
To some extent, it is part of ageing: as people get older, their valves become less flexible, and more stretched or torn.
And experts are concerned that the UK is poorly prepared for what is certain to be a big increase in cases.
Data from the latest National Adult Cardiac Surgery Database for Great Britain and Northern Ireland shows wide variation in treatment provision.
More than a third of those undergoing surgery to repair their defective heart valves had advanced disease, significantly increasing their likelihood of complications, death, and ineffective symptom relief, researchers told Heart journal.
"These observations suggest that both initial diagnoses and subsequent follow up are currently inadequate and that patients are routinely referred late in the natural history of the condition, beyond the window where surgery is of maximum benefit," they said.
The surgeons were based at Oxford's John Radcliffe Hospital, London's St Thomas' Hospital and the University Hospital of South Manchester.
Ageism and sexism also seem to be factors, with twice as many men undergoing aortic valve replacement as women, and patients over the age of 75 with moderate to severe disease half as likely to be treated surgically as their younger counterparts.
"Advancing age is often used to justify the decision to withhold surgery, but suitably selected patients may derive considerable improvement in symptomatic burden and overall quality of life, following successful intervention," they say.
Mr Ben Bridgewater, a heart surgeon from South Manchester University Hospital, and colleagues are calling for specialist centres to be set up, staffed by specialists with access to the right screening tests and equipment to treat patients with VHD.
"VHD has been relatively neglected by politicians, health economists and even by cardiologists," they say.
"National programmes already exist for heart failure and coronary disease. A similar coordinated approach to research, education, and clinical management is now needed to ensure improved outcomes for all patients with VHD."
Professor Peter Weissberg of the British Heart Foundation said: "The authors of this paper are right to point out that the NHS will need appropriately skilled health care professionals to identify and deal with patients of all ages - particularly the elderly - with valve disease.
"It is well established that patients with all types of heart disease have a better chance of survival and quality of life when managed by an expert cardiological team.
"It is essential that all hospitals maintain and indeed expand their expert cardiac services over the coming years to avoid the financial and health costs of not dealing with the changing pattern of heart disease in an expert and timely manner."