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New Minimally Invasive Procedure Gives Heart Patients More Options

February 23, 2017

Previously, patients with mitral valve regurgitation (MR) had very few options if they weren’t candidates for surgery. The condition, in which one of the heart valves does not close tightly, allowing blood to flow backward into the heart’s left chamber, can lead palpitations, difficulty breathing and fluid build-up in the lungs in patients who have a severe form of this heart disorder.

Treatment often has included heart failure medications, anticoagulation medications, which reduce the risk of blood clots caused by poor circulation or surgery to repair or replace the mitral valve, one of the two major valves on the heart’s left side.

But some patients, either because of their age or health, aren’t good candidates for surgery and medication only manages rather than cures their condition. For these patients, a transcatheter mitral valve repair using a device called a MitraClip usually is the best option.

What is a MitraClip?

MitraClip is a catheter-based device. A transcatheter mitral valve repair does not involve opening the chest or stopping the heart, so it is less invasive than open surgery. During the procedure, we access your heart through a vein in your leg and deploys a clip to group the leaky leaflets. The normal dimension of a mitral valve is between 4 to 5 square centimeters, but due to heart failure, a congenital heart defect, coronary artery disease or the long-term use of certain medications, the valve doesn’t fully closed and can leak with every heartbeat. If there’s a leaky valve, we can go in with a catheter, cross from the right side to the left side of the heart and look down into the valve. We then put in the MitraClip, which pulls the leaflets, or two flaps of the mitral valve, together to reduce the size of the opening and repair the leak. The clip essentially works by tightening the leaky valve, so that blood flows more efficiently through the heart’s chambers.

The medical community is starting to focus more on the mitral valve, and this has led to more therapeutic options for patients. Researchers also are investigating more techniques to repair or replace this valve, such as an approach that involves inserting a catheter into the ventricle.

Even patients who cannot get an open procedure can get a quick valve replacement using one of these novel techniques.

The MitraClip procedure is relatively new and has been done in the U.S. over the last five to six years as a part of clinical trials. In the last three years or so, this procedure has become FDA- approved. MitraClip is now out in clinical practice and is slowly gaining popularity. So far, more than 20,000 patients all over the world have been treated with this device. Currently, only about six hospitals in the state of Florida offer MitraClip. Orlando Health is one of them.

Only a small group of patients we see require this approach. If someone is young and healthy enough for surgery or doesn’t have advanced heart failure, then surgery is the preferred treatment option. There are two types of surgical options: a replacement to take out the defective valve and put in a brand new valve or a repair to just fix specific parts of the defective valve.

In comparison to surgery, the MitraClip hospital stay is shorter (an average of 2.9 days, according to clinical data). It also leads to better quality of life for patients compared to medical management only.

MitraClip has now expanded the repair options we have for MR patients, allowing us to treat patients using a minimally invasive approach. It leads to improved health outcomes such reduced lung pressure, better breathing, improvement of heart failure symptoms, reduced fluid build-up and reduced hospitalization. It also reduces patients’ risk of other related illnesses, such as pneumonia, that often are elevated because of heart valve issues.

The Benefits and Limitations of Treatment

It’s important to stress that MitraClip isn’t a be-all, end-all solution for patients with MR. The goal of this treatment is to reduce the degree of the leak. Its intention isn’t to completely bring down the leak to zero, but to facilitate a significant reduction. This device’s greatest success is that more patients are being treated that were previously just being managed with medication.

Unfortunately, there is very little you can do to prevent mitral valve issues. It’s a problem that develops with age. Most of these changes relate to other chronic conditions or genetic-related valve deteriorations that occur over time. Though you cannot easily prevent conditions like MR, you can have your heart checked by your cardiologist to permit timely intervention. If there’s a problem, always ask about treatment options. If you’re being treated with medications, ask your doctor what surgical or minimally invasive treatments might be best for you. Thanks to medical and technological advancements, treatment techniques have improved substantially and surgeons are more trained in complex mitral valve repair techniques. With more technology becoming available, we should be able to overcome this heart problem and give people with mitral valve defects the chance at a better quality of life.

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