April 24, 2019 by John Fernandez
New Ways to Mend Broken Hearts
Every February, hearts get all their glory. Valentine’s Day and American Heart Month focus our attention on both the symbolic hearts, representing love and relationships, and the hearts within us that keep our body’s blood flowing.
While the love-scorned can ignore Valentine’s Day and their broken hearts, people with heart-valve problems – “broken” biological hearts – cannot ignore the treatments they need to restore proper function.
Valvular disease, resulting from damaged or faulty heart valves, causes insufficient blood flow between the chambers of the heart or from the heart to the rest of the body, according to the National Institutes of Health. The American Heart Association says the two most common problems that valve disease leads to are stenosis and regurgitation. When valves are not able to function properly, a decreased amount of blood gets through the valve. This can be the result of valves narrowed by stenosis, or calcifications on the valve, or from valves that don’t close all the way and allow blood to flow backward, or regurgitate. The heart must pump harder and more often to keep up with the demands of the body. After awhile, the heart weakens significantly and the valves need to be repaired or replaced altogether.
“For most people, heart surgery is recommended to treat advanced valvular disease, either through a valve repair or a valve replacement,” said Niberto Moreno, M.D., a Baptist Health Medical Group heart surgeon and Chief of Cardiothoracic Surgery. Yet for some, open heart surgery is too risky.
For those people who cannot undergo open heart surgery, two types of minimally-invasive procedures may be options to fix the valves. Transcatheter aortic valve replacement (TAVR) treats stenosis of the aortic valve and MitraClip treats blood regurgitation through the mitral valve.
Transcatheter Aortic Valve Replacement (TAVR)
During a TAVR procedure, an artificial heart valve is delivered through a catheter, or hollow wire, threaded from outside of the body to the inside of the heart. Then, the replacement valve is anchored in place using the tissue of the original valve, says Ramon Quesada, M.D., medical director of interventional cardiology and research at Baptist Cardiac & Vascular Institute.
TAVR, Dr. Moreno says, offers a better quality of life for patients with inoperable severe aortic valve stenosis than treating them with medication alone.
For patients with severe mitral valve regurgitation or insufficiency, Dr. Quesada evaluates them for a valve repair using the MitraClip, a device manufactured by Abbott Laboratories that was approved last year by the Food and Drug Administration.
Dr. Quesada led a clinical trial over a six-year period at Baptist Cardiac & Vascular Institute to determine the effectiveness of the MitraClip to repair the valve leading from the upper left chamber of the heart to the lower left chamber of the heart.
With mitral valve repair using the MitraClip, Dr. Quesada threads the device through a catheter inserted into a vein in the groin and up into the heart, crossing the septum, or inner wall of the heart, from one upper chamber of the heart to the other. The clip of the MitraClip then grasps the two flaps of the mitral valve and helps them close.
“This device is not for everyone,” Dr. Quesada stressed about the MitraClip. “Only 50 of the more than 400 patients we’ve screened over the last six years have been candidates for this procedure. But, we will be testing the second generation of these devices to see if different mechanisms also can be delivered to the heart endovascularly to treat other structural and valvular defects. The evolution of transcatheter heart repair is amazing.”
Dr. Moreno echoes that sentiment.
“These new approaches for high-risk patients add to our ability to give more patients a better quality of life and lengthen their lifespan,” he said. “We’re on the leading edge of the research going on in this area, and our team approach between the surgeons and interventional cardiologists has helped our patients do better than with traditional interventions and medications.”
So, while broken hearts from love lost tend to heal over time, a broken heart muscle won’t without the care of skilled surgeons and cardiologists who take their love of your heart very seriously throughout the year – not just in February.