Transcatheter Mitral Valve Repair

What is Mitral Regurgitation?

 The heart has four valves to ensure that blood flows in one direction through the heart. On the left side of the heart, blood returns with oxygen from the lungs into the left atrium, passes through the mitral valve into the left ventricle, which then pumps blood through the aortic valve to the body. Mitral regurgitation (MR) occurs when the mitral valve fails to close properly, so some of the blood the heart pumps leaks backwards into the left atrium. In rare circumstances, MR may develop acutely and be severe, posing a life-threatening situation. More commonly, it develops gradually and is detected by the presence of a heart murmur. Over time, the heart will enlarge, the back pressure from regurgitant flow will increase pressure in the lung vessels, and an irregular heart beat called atrial fibrillation may develop. With increasing leakage, a patient may develop fatigue and shortness of breath with less activity. Eventually, if left untreated, the left ventricle will become severely dilated and weaker, causing worsening "congestive heart failure" which carries a very poor prognosis. 

The mitral valve resembles a parachute with two valve leaflets and strings ("chords") that attach the leaflets to muscles arising from the left ventricular wall ("papillary muscles"). Abnormalities in any of these can cause mitral regurgitation. Surgery has generally been indicated to correct MR when the patient develops symptoms or there is evidence that the heart is becoming significantly enlarged or becomes weaker. In addition, when the lung artery pressure is significantly increased or atrial fibrillation develops, surgery should be considered.

Transcatheter Mitral Valve Repair

side-viewSurgery is the most effective means of eliminating significant MR, improving symptoms, and improving long-term survival. Mitral valve repair is preferable for patients with "degenerative" MR, whereas mitral valve replacement may be best for "functional" MR. However, some patients will have congestive heart failure from severe leakage but are considered too high risk to tolerate surgery. These include very elderly patients, those with multiple other medical problems, and patients with severely decreased heart muscle function. The MitraClip system is a means of improving valve leakage without open-heart surgery. Using access through the femoral vein in the groin, a catheter is passed into the heart and across the muscle between the upper two chambers. The device is then advanced across the mitral valve, and two clips grasp the anterior and posterior leaflets of the valve to bring the leaflets together at the same plane. This creates a double-inlet into the left ventricle with reduction in the leak with minimal narrowing.

Am I a Candidate for a MitraClip? 

This device is only approved for patients considered at prohibitive risk for surgery because surgery is a much better means of eliminating the MR and is otherwise preferable. Studies in the United States have shown benefit for patients with degenerative MV disease, while studies in Europe show that it is effective for functional disease. The latter indication is not yet approved in the United States, pending results of a large trial. A careful evaluation of your history, medical problems, overall physical condition, and a detailed analysis of your echocardiogram will determine whether the procedure is indicated or feasible. Patients with significant comorbidities, complex mitral valve disease, severe right ventricular dysfunction, and severe tricuspid regurgitation may not benefit from the procedure.

What Should I Expect if My Doctor Recommends an Evaluation for a MitraClip?

If your doctor suspects that you have severe mitral regurgitation, an echocardiogram is performed to confirm the severity of the leakage and the suspected mechanism for the leak. A referral to our Advanced Structural and Valvular Heart Disease program can provide you with an evaluation by our Heart Team of cardiologists, cardiothoracic surgeons, and echocardiography experts. We will carefully review your echocardiogram and decide whether you should be considered for surgery. This may require a transesophageal echocardiogram at Saint Vincent to obtain a better assessment of your mitral valve. If surgery is not feasible, but the anatomy appears favorable for a MitraClip, we will then meet with you to discuss the nature of the procedure, and its risks and benefits. 

Preparing for the MitraClip Procedure

atrial-view coapting leafletsThe procedure is performed in our new hybrid cath lab which provides state-of-the-art technology. It is performed under general anesthesia which allows us to perform a transesophageal echocardiogram during the implantation which can take several hours. During preadmission testing, you will meet with an anesthesiologist who will review your history, medications, and lab tests. Some patients require admission the day before the procedure, especially those on anticoagulation, while others may be admitted the morning of the procedure. Instructions on preparing and arriving for the procedure will be given to you in advance. 

Results of MitraClip

The MitraClip procedure has been successfully implanted in just over 90% of patients and the degree of MR has been reduced to moderate or less in degree in 90% of patients. The long-term results are not known, since this is relatively recent technology, but the significant reduction in MR in most patients should lead to an improved quality of life and most likely increase longevity. 

Our specialized team of providers will arrange all of your appointments, schedule pre-admission testing, perform the procedure, follow you throughout your hospitalization, and arrange follow-up appointments after discharge.

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4 Heart Health Tips

Do you know someone who has heart disease? Chances are you do. More than 28 million Americans have been diagnosed with the condition. If you don’t want to join this group, pay attention to these heart health tips to reduce your personal risk of heart disease.

Tip #1: Eat healthy. 
A healthy diet includes a variety of grains (especially whole grains), fruits and vegetables. Opt for foods low in saturated and trans fats, cholesterol, added sugar and salt. Choose fish, poultry and lean cuts of meat, as well as low-fat or fat-free dairy products. Limit the number of egg yolks and cut down on processed cold cuts. When preparing food, broil, bake, roast or poach instead of frying, and tame snack attacks with low-fat options, such as animal crackers or fat-free yogurt. Another heart health tip is to limit how much alcohol you drink. Too much alcohol can raise blood pressure (more than two drinks per day for men and one drink per day for women).

Tip #2: Exercise regularly. 
As little as 30 minutes of moderate-intensity physical activity on most days of the week is all you need to protect heart health. Don’t like to exercise? No sweat. Good ways to keep your heart healthy include brisk walking, riding a bike, hiking, dancing, swimming, physical tasks around the house, raking leaves or painting a room. Other ways to work exercise into your day include taking the stairs when possible, or parking farther away from the office and then walking the added distance.

Tip #3: Don’t smoke. 
According the Centers for Disease Control and Prevention, smoking is “the leading cause of preventable disease, disability and death and disease in the United States.” Compared to nonsmokers, smokers are at an increased risk of heart disease due to the buildup of plaque in their coronary arteries overtime. Quitting smoking can lower the risk of heart disease – and just one year of not smoking may cut heart disease risk in half.

Tip #4: Maintain a healthy weight. 
A healthy weight can be calculated by looking at either body mass index (BMI) or waist circumference. BMI, a calculation based on height and weight, of 25 to 29.9 is considered overweight, and 30 or higher is obese. A waist measurement of more than 35 inches for women and 40 inches for men increases the risk of heart disease, high blood pressure and other serious health conditions. A weight loss of just five to 10 percent of current weight can help lower the risk for heart disease. Gradual weight loss of one-half to two pounds per week is recommended to ensure long-term success.

Get Regular Checkups! 

In addition to making lifestyle changes, you should also have blood pressure and cholesterol levels checked on a regular basis. Hypertension of 140/90 mmHg or higher is a major risk factor for heart disease that usually does not cause symptoms. Total cholesterol of 240 mg/dL and above is an indication of too much cholesterol that can eventually accumulate on artery walls, making them narrow and impeding blood flow to the heart. 

It is important to remember that regardless of your age or current state of health, it is never too late to practice heart health tips to protect your heart. For more information about heart health, talk with your doctor.