March 27, 2020 by John Fernandez
Heart Valve Disease: Minimally Invasive Advances Helping Save More Lives
When it operates normally, the heart is a remarkably efficient organ, with the vital help of four valves that directs blood in out of each chamber. When the valves are diseased or structurally deficient, the result can be deadly.
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. Heart valves can have three basic kinds of problems: regurgitation, stenosis (narrowing), and atresia (lacking an opening for blood to 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 any problems. But for others, heart valve disease slowly worsens until symptoms develop. 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’
“Awareness of heart valve disease is very important,” says Dr. Quesada. “When the patient is present early enough, there may be more treatment options. There have been many advances over the past few years, but this is still a relatively new field of cardiovascular disease. The symptoms can be very insidious and not so obvious. And there is still a high mortality (death rate) among certain patients with heart valve disease.”
Currently, no medicines can cure heart valve disease. However, lifestyle modifications — including healthier eating and regular exercise — and medicines can relieve many of its symptoms and complications. But severe heart valve disease can lead to very serious structural issues that affect the heart’s ability to pump blood in or out of its chambers. These patients may need to have their faulty heart valve repaired or replaced.
Pioneering Work with TAVR, MitraClip
That’s when advanced, minimally invasive procedures may come into play. Last summer, a team at Miami Cardiac & Vascular Institute, led by Dr. Quesada, became the first in Florida, and the second in the Southeast U.S., to perform an aortic valve replacement on a patient using a new device, the Lotus Edge, which had been approved by the U.S. Food and Drug Administration (FDA). It was the Institute’s first “transcatheter aortic valve replacement,” or TAVR as it is more commonly known, using the Lotus Edge. Without TAVR, some patients face to many risks and severe side effects from open-heart surgeries.
Dr. Quesada and his team at the Institute have also taken a leading role in treating patients with mitral valve prolapse, and other abnormalities that do not allow one of the heart’s four valves to close properly. The FDA last year also approved broader use of the MitraClip procedure, a less invasive approach than traditional — and much riskier — open-heart surgery, and is intended for patients who are not candidates for surgery.
The MitraClip device is inserted through the groin via a catheter, and advanced into the left side of the heart. The MitraClip reduces moderate-to-severe or severe MR (mitral regurgitation) — a leakage of blood backward through the mitral valve into the heart’s left atrium that can cause heart failure symptoms, such as shortness of breath, fatigue and swelling in the legs.
“Mitral valve insufficiency (when the mitral valve does not close properly) can progress 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 mitral insufficiency. But the MitraClip procedure is an interventional procedure that can improve symptoms, quality of life and survival.”
More Amazing Results Ahead
TAVR, which replaces the aortic valve, had been a last-resort option for patients at high risk for open-heart, traditional surgery. In coming months, it is also poised to become a superior option to those heart-valve replacement candidates who are considered “low risk” for open-heart surgery. The expansion of this procedure by the FDA followed the recent release of large clinical trials that found TAVR to be more effective — compared to traditional surgery — for younger, healthier patients.
“Heart valve disease can be degenerative and progressive,” says Dr. Quesada. “And it is becoming more common as more people live longer and survive heart attacks. This field has evolved tremendously and, over the next 10 years, it is going to produce amazing results for many more patients.”