A new device is now available that offers more patients who have mitral valve regurgitation a treatment option that doesn’t require open-heart surgery. Mitral valve regurgitation is the most common heart valve problem, and until recently, the only way to repair mitral valves was through open-heart surgery.
Mitral valve leakage affects a significant number of people — nearly one in 10 of those age 75 and older — although many cases are fairly mild. The condition may be progressive and life-threatening, and, because of the extra work the heart performs to get blood throughout the body, it can increase the risk of irregular heartbeats, stroke and heart failure.
No available medication can correct mitral regurgitation, but medications are often prescribed to relieve symptoms, which include shortness of breath; lack of energy or stamina, especially during exercise; lightheadedness; heart palpitations; and swelling of the legs and feet. These symptoms often place serious limitations on normal daily activities.
The MitraClip Clip Delivery System offers a minimally invasive solution to mitral valve repair for patients who are not good candidates for open-heart surgery.
Bassem Chehab, MD
“It is a percutaneous valve repair reserved for people who have moderate-to-severe or severe mitral valve leakage,” says Bassem Chehab, MD, Medical Director of Via Christi’s structural heart program. “This procedure is for those patients who we feel would have a prolonged recovery or would have complications from open-heart surgery.”
Minimally Invasive Procedure
The FDA approved use of the MitraClip device in the United States in October 2013. Via Christi Hospital St. Francis is one of only 56 hospitals in the country that are approved to perform the procedure, which is a beating-heart procedure requiring no cardiopulmonary bypass.
The clip is delivered venously, with entry of the catheter delivery system in the right common femoral vein, with no need for surgical cutdown. The clip is then directed upward to the heart’s right atrium. Then, the interatrial septum is pierced to gain access to the left atrium.
The MitraClip system was approved by the FDA in October 2013. It offers a minimally invasive method to correct mitral regurgitation in patients who are not good candidates for open-heart surgery.
“Through that access, we are able to telescope the clip into place,” says Dr. Chehab. “We use 3-D and 4-D echocardiography to guide the clip into place.”
This illustration shows the delivery of the clip through the interatrial septum and in place below the mitral valve before being closed.
A state-of-the-art fluoroscopy machine identifies the exact location of the leak in the valve and allows the team to target the valve repair.
Once physicians and technicians have identified the target area, the clip is directed to that spot and clips the edges of the valve together to minimize leaking. This helps the heart function more efficiently, which relieves symptoms and improves the patient’s quality of life, Dr. Chehab says.
Because the surgery is minimally invasive, the recovery period for patients is significantly reduced.
“The average post-surgery hospital stay for patients who undergo this procedure is about one to two days, as compared with one to two weeks for traditional mitral valve surgery,” says Dr. Chehab. “MitraClip significantly improves our patients’ quality of life, with less need for diuretics and other medications. They are able to go home and immediately participate in more activity than they were before the surgery.”
A Streamlined Process
The Via Christi structural heart team, which includes a heart failure specialist, heart surgeon, structural cardiologist, anesthesiologist, imaging specialists and others, works closely together, with the goal of finding the best option for each patient.
Bassem Chehab, MD, right, and Brett Grizzell, MD, use the MitraClip device to guide the clip into place to repair the patient’s leaking mitral valve.
In addition, this team works with the patient, the patient’s family and the patient’s referring physician, keeping everyone informed of care decisions throughout the process of deciding if the MitraClip is indeed the best solution for the patient.
All evaluations are performed in the Heart Valve Clinic at Via Christi Hospital St. Francis, and this allows the patient to see all the necessary specialists in one visit, without having to travel to several different offices.
Streamlining the process for the patients and their families helps make what can be a highly stressful situation a little easier, especially for those who have to travel some distance.
The work done with the patient through the Heart Valve Clinic paves the way for the actual procedure to take place in the hybrid OR at St. Francis.
Quality Heart Care
Darrell Youngman, DO
“It speaks to the quality of heart care we provide at Via Christi that Abbott Laboratories named us a provider for MitraClip therapy,” says Darrell Youngman, DO, Chief Medical Officer for Via Christi. “The MitraClip was approved by the FDA less than a year ago, and we are among the first centers in the country to provide the procedure, which indicates the level of confidence Abbott has in our ability to move this procedure ahead.”
The right mix of people, facility and experience is important in identifying what hospitals can perform new procedures, says Dr. Chehab.
“To be one of the first centers in the nation to offer MitraClip took a lot of support in the earliest stages from the administration at Via Christi,” he adds. “They saw early on the benefits of adding the hybrid OR and what it could do for our region.”
The hybrid OR is driven by technology necessary for procedures such as the MitraClip and transcatheter aortic valve replacement. The structural heart team is human-driven, and Dr. Chehab stresses that you have to have both elements for the MitraClip procedure to be a success.
“The MitraClip is widely applicable and not widely available in the area, so it really expands the number of people we can help here,” says Dr. Youngman.
For more information about the MitraClip procedure and heart care at Via Christi, visit viachristi.org/heart or call the Heart Valve Clinic at 316-268-8650.