The pioneering hospital, housed in a collection of outdated buildings in Hillingdon close to the M25, looks certain to be moved as part of wider government plans to build a pounds 200m super-hospital on der-elict land in central London.
Frank Dobson, the Health Secretary, is expected to approve the closure of Harefield to make way for a specialist heart hospital next to St Mary's Hospital in Paddington.
The Royal Brompton Hospital in Chelsea, which was merged with Harefield to form a single NHS trust specialising in heart surgery last year, would also be closed and some of its staff and services transferred to the new unit in Paddington Basin.
Several options for the future of Harefield have been considered by clinicians and health authority chiefs, but senior government sources have now indicated that the Paddington alternative is the most likely to win approval. "We want a Harefield for the 21st century, a world-beater," the source said.
A key factor in the decision has been the reluctant admission by Professor Yacoub that his long campaign to keep the Harefield on its site in Hillingdon cannot be sustained. The surgeon was keen to ensure that the team of experts he had built up over the past 20 years would not be disbanded and lobbied Mr Dobson as recently as November. He is believed to have received assurances that the team would be preserved in the new hospital.
Harefield has been an international centre for heart transplant surgery since the early 1980s, and for years it was performing more of the operations than any other centre in the world. But in the 1990s, as other hospitals have developed expertise, the number of transplants performed at Harefield has declined from 200-plus a year to between 85 and 90.
Pressure to transfer the paediatric work from Harefield to a larger specialist centre has grown since the Bristol heart disaster, which pinpointed the need for dedicated paediatric surgeons to operate on children. At Bristol, three doctors, including two adult surgeons, were found guilty of serious professional misconduct after 29 out of 53 babies died.
Visitors to the Hillingdon hospital, built in the Thirties, are astonished that world-class surgical research can have been accomplished in such a dowdy setting. When Mr Yacoub began the heart transplant programme in 1980, the hospital was thrown into disarray because the programme demanded more resources than it could afford. His formidable presence and evident skill ensured the programme survived and prospered, though critics said it was at the expense of work of equal importance to patients.