‘Structural Heart’ Treatment: Transcatheter Mitral Valve Repair with MitraClip Expands Options

Removal from a ventilator was a milestone moment for a patient recovering from parainfluenza in Baptist Hospital’s intensive care unit. But when that patient regressed and had to be reintubated numerous times due to respiratory failure, the multidisciplinary care team collaborated to identify the complex, underlying problem.

For this female patient in her 60s, that problem was mitralvalve regurgitation – a condition that occurs when the mitralvalve on the left side of the heart does not close properly, allowing blood toflow backward in the heart.

“The patient’s echocardiogram revealed severe mitral regurgitation with a flail leaflet, and we could see fluid backing up into her lungs,” explained Elliot Elias, M.D., an expert in interventional echocardiography and member of the structural heart team at Miami Cardiac & Vascular Institute. “We tried medications and performed a thoracentesis to remove the fluid. Despite these efforts, every time she was removed from the ventilator, she had to go back on it within 24 hours because of the severity of the regurgitation.”

Since mitral regurgitation was the major contributing factor for the patient’s inability to stay off ventilation, the care team considered surgery to repair the condition. Some people, however; cannot undergo traditional open-heart surgery to repair the mitral valve, says the patient’s consulting surgeon, Niberto Moreno, M.D., cardiothoracic surgeon and chief emeritus of cardiovascular surgery at Miami Cardiac & Vascular Institute. For these patients, a transcatheter mitral valve repair with MitraClip can correct the problem. In this case, it also enabled the care team to avoid a tracheostomy.

Ramon Quesada, M.D., medical director of the Structural Heart and Complex Percutaneous Coronary Intervention Programs at Miami Cardiac & Vascular Institute, performed the MitraClip procedure while Dr. Elias provided the intraoperative imaging guidance that enabled Dr. Quesada to see the heart’s structures during the minimally invasive procedure. The MitraClip device was inserted through the patient’s groin via a catheter and advanced into the left side of her heart.

“Thispatient’s mitral regurgitation had led to severe refractory congestive heartfailure, making her an extreme surgical risk and transcatheter mitral valverepair with MitraClip the only viable alternative,” said Dr. Quesada, who hasspearheaded pioneering work involving minimally invasive procedures to repairor replace mitral heart valves at the Institute. “Sheunderwent a successful procedure and was weaned off the ventilator within 48hours and discharged home a few days later.”

Dr.Quesada also performed the MitraClip procedure on a male patient who had severemitral regurgitation and was experiencing worsening symptoms of the condition,including shortness of breath, fatigue andchest pain.If left untreated, his severe heart valve disease could have led to heartfailure, stroke, blood clots or death due to sudden cardiac arrest. But sincethe patient had undergone open heart surgery in 2014, he also was not a goodcandidate for traditional surgery with sternotomy, says Dr. Moreno.

“TheMitraClip procedure expands our ability to take care of patients with thiscondition and improve their symptoms, quality of life and survival,” Dr. Morenoexplained.

Transcatheterprocedures are performed while the patient’s heart is still beating,eliminating the need for a “heart bypass” machine and its associated risks. Anddue to the minimally invasive nature of the MitraClip procedure, these twograteful patients had shorter hospital stays, recovered faster and experiencedan improvement in symptoms soon after their procedures were completed.