September 28, 2022 by KiKi Bochi
‘Every Day I Feel Stronger’ — At 81, He’s Resuming An Active Life After Major Structural Heart Procedure at Miami Cardiac & Vascular Institute
David Villari, a Fort Lauderdale resident who turns 81 in September, is mostly retired from running his family-owned insurance business. He stays active by exercising and participating in sports activities, but mainly by playing golf and spending time with his large family, including five grandchildren – one of whom is also an avid golfer.
Then in April, Mr. Villari recalls when he started feeling a flare-up of symptoms — primarily bouts of weakness with shortness of breath — that would lead to a major structural heart procedure at Miami Cardiac & Vascular Institute, part of Baptist Health.
(Watch video: Hear from patient David Villari and Ramon Quesada, M.D., medical director of Structural Heart and Complex Percutaneous Coronary Intervention at Miami Cardiac & Vascular Institute. Video by Alcyene de Almeida Rodriguez.)
“I was feeling weaker by the day,” he said. “I was fairly active but I got tired very quickly. I played golf regularly and I would wear down after one round of golf. So, I knew there was something wrong.”
In 2007, Mr. Villari successfully underwent open-heart bypass surgery and aortic valve replacement, but his doctors at the time cautioned him that he may need aortic valve repair at some point. Heart valve disease occurs if one or more of the heart valves — the tricuspid, pulmonary, mitral, and aortic valves — do not open fully or they allow blood to leak back into the chambers.
For years, pivotal advances in treating or replacing heart valves, many of them initiated as part of clinical trials, have been pioneered at Miami Cardiac & Vascular Institute led by Ramon Quesada, M.D., medical director of Structural Heart and Complex Percutaneous Coronary Intervention at the Institute.
“I went to my cardiologist who suggested that I go through a TEE (transesophageal echocardiogram) test to see if my aortic valve was failing,” recounts Mr. Villari. “As it turned out, it was my mitral valve. The mitral valve was leaking (mitral valve regurgitation). And at that point, I talked to a friend of mine at Baptist Health, Dr. Bernie Fernandez (Bernie Fernandez, Jr., M.D., chief executive officer of Baptist Health Medical Group), and he recommended Dr. Quesada.”
Mr. Villari’s condition did not involve his aortic valve, as his previous medical team suspected. Following the TEE, which uses ultrasound to make detailed pictures of the heart, he was diagnosed by Dr. Quesada with mitral valve insufficiency, or mitral regurgitation (MR). MR refers to leakage of blood backward through the mitral valve each time the left ventricle contracts. A leaking mitral valve allows blood to flow in two directions during the contraction. Some blood flows from the ventricle through the aortic valve — as it should — and some blood flows back into the atrium, which is not normal.
For these patients presenting MR, a transcatheter mitral valve repair with MitraClip can correct the problem. A small implanted clip is attached to the mitral valve to help it close more completely.
“We proceeded with the plan of transcatheter mitral valve repair with mitral clips. So, this is the primary micro insufficiency rule. So technically a more difficult procedure than doing functional or secondary Mitral insufficiency. So, he required multiple clips to reduce the Mitral insufficiency from torrential, which is more than severe, to mild, which is where we end up at the end of the procedure.”
Dr. Quesada said Mr. Villari’s mitral valve issue was severe. Mitral valve prolapse, or MVP, is one of the most common structural heart conditions. It can be a simple condition, but it can evolve into a very serious one, as was the case with Mr. Villari. The degeneration of the mitral valve can produce severe mitral valve deficiency and MVP, and that’s when the term “floppy valve syndrome” applies. That’s when the mitral valve’s two flaps don’t close smoothly or evenly, but bulge (prolapse) upward into the left atrium. When MVP is severe enough to cause significant leakage, called “regurgitation,” it can lead to serious complications such as heart attack and stroke.
Since 2006, the Institute also has been at the forefront of MitraClip procedures and involved in many clinical trials. As a result of the Institute’s success in these trials, the MitraClip was introduced in 2013 to treat patients with MVP, and other abnormalities that does not allow the mitral valve to close properly.
Mr. Villari’s procedure also involved the use of an innovative new system to create a small surgical passage through the atrial septum — the wall between the right and left atrium of the heart. This system, known as SafeCross, reduces the risk of atrial wall perforation. The Institute was the first medical center in Florida to start using SafeCross in April.
“How many clips are needed depends on the anatomy of the patient,” explains Dr. Quesada. “There are no limits as to how many clips you need. One thing you have to make sure is that you don’t obstruct the mitral valve at the end. That’s one of the considerations that we always keep in mind when doing these complex procedures. Fortunately, we got a great result with Mr. Villari, and we were able to reduce significantly the amount of mitral insufficiency. And we minimized the degree of obstruction to the mitral valve at the end. And clinically, he has done extremely well.”
Mr. Villari recalls Dr. Quesada coming into his hospital room after the procedure to explain the complexity of his mitral valve repair. “He explained that instead of one mitral clip I needed three. It was a much more extensive procedure than we originally thought. And I was pleased to hear that I survived because it was such a complex procedure.”
Dr. Quesada said the patient’s recovery has been ideal. Mr. Villari emphasizes that he always felt he was in the right hands and is grateful for a quick recovery.
“I was in the hospital overnight and part of the next day after the procedure,” Mr. Villari recalls. “I immediately felt much better. And I had a much easier time of breathing. I wasn’t as tired as I was prior to the surgery. I felt more energized. So, it was a very successful procedure as I was concerned. And I knew that two days afterward. I felt quite better. I’m not at a 100 percent just yet, but I’m getting there very rapidly. I feel much better every day, and every day I feel stronger.”