Heart Valve Disease: Minimally Invasive Advances Helping Save More Lives

When itoperates normally, the heart is a remarkably efficient organ, with the vitalhelp of four valves that directs blood in out of each chamber. When the valvesare diseased or structurally deficient, the result can be deadly.

Heart valvedisease 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 backinto the chambers. Heart valves can have three basic kinds of problems:regurgitation, stenosis (narrowing), and atresia (lacking an opening for bloodto flow through).

Saturday, Feb. 22, marks Heart Valve Disease Awareness Day. The designation, which comes during American Heart Month, is significant because many people have heart valve defects or disease — but don’t have symptoms, explains Ramon Quesada, M.D., medical director of Structural Heart and Complex Percutaneous Coronary Intervention at Miami Cardiac & Vascular Institute.

Dr. Quesada has spearheaded pioneering work involving minimally invasive procedures to repair or replace aortic and mitral heart valves at the Institute.

For some,heart valve disease remains stable throughout their lives and doesn’t cause anyproblems. But for others, heart valve disease slowly worsens until symptomsdevelop. If not treated, advanced heart valve disease can cause heart failure,stroke, blood clots, or death due to sudden cardiac arrest.

‘Symptoms can be Very Insidious’

“Awarenessof heart valve disease is very important,” says Dr. Quesada. “Whenthe patient is present early enough, there may be more treatment options. Therehave been many advances over the past few years, but this is still a relativelynew field of cardiovascular disease. The symptoms can be very insidious and notso obvious. And there is still a high mortality (death rate) among certainpatients with heart valve disease.”

Currently,no medicines can cure heart valve disease. However, lifestyle modifications —including healthier eating and regular exercise — and medicines can relievemany of its symptoms and complications. But severe heart valve disease can leadto very serious structural issues that affect the heart’s ability to pump bloodin or out of its chambers. These patients may need to have their faulty heartvalve repaired or replaced.

Pioneering Work with TAVR, MitraClip

That’s whenadvanced, minimally invasive procedures may come into play. Last summer, a teamat Miami Cardiac & Vascular Institute, led by Dr. Quesada, became the firstin Florida, and the second in the Southeast U.S., to perform an aortic valvereplacement on a patient using a new device, the Lotus Edge, which had beenapproved by the U.S. Food and Drug Administration (FDA). It was the Institute’sfirst “transcatheter aortic valve replacement,” or TAVR as it is more commonlyknown, using the Lotus Edge.  Without TAVR, some patients face to many risks and severe side effects fromopen-heart surgeries.

Dr. Quesadaand his team at the Institute have also taken a leading role in treatingpatients with mitral valve prolapse, and other abnormalities that do not allowone of the heart’s four valves to close properly. The FDA last year alsoapproved broader use of the MitraClip procedure, a less invasive approach thantraditional — and much riskier — open-heart surgery, and is intended forpatients who are not candidates for surgery.

TheMitraClip device is inserted through the groin via a catheter, and advancedinto the left side of the heart. The MitraClip reduces moderate-to-severe orsevere MR (mitral regurgitation) — a leakage of blood backward through themitral valve into the heart’s left atrium that can cause heart failuresymptoms, such as shortness of breath, fatigue and swelling in the legs.

“Mitralvalve insufficiency (when the mitral valve does not close properly) canprogress to the point of the ventricle getting deteriorated and, in the past,we thought that was a point where we could not do anything,” explains Dr.Quesada. “Before, risky surgery was the only option for severe mitralinsufficiency. But the MitraClip procedure is an interventional procedure thatcan improve symptoms, quality of life and survival.”

More Amazing Results Ahead

TAVR, whichreplaces the aortic valve, had been a last-resort option for patients at highrisk for open-heart, traditional surgery. In coming months, it is also poisedto become a superior option to those heart-valve replacement candidates who areconsidered “low risk” for open-heart surgery. The expansion of this procedureby the FDA followed the recent release of large clinical trials that found TAVRto be more effective — compared to traditional surgery — for younger, healthierpatients.

“Heartvalve disease can be degenerative and progressive,” says Dr. Quesada.“And it is becoming more common as more people live longer and surviveheart attacks. This field has evolved tremendously and, over the next 10 years,it is going to produce amazing results for many more patients.”