Advances in imaging techniques are making it possible for more patients than ever to be treated for valve and structural heart problems.
Being able to envision the unique anatomy of a patient’s heart before surgery allows for strategic planning of repairs without having to open the chest, says Elliott Elias, M.D., medical director of cardiac and structural imaging for Baptist Health Miami Cardiac & Vascular Institute.
Elliott Elias, M.D., medical director of cardiac and structural imaging for Baptist Health Miami Cardiac & Vascular Institute.
In addition, real-time imaging during minimally invasive, catheter-based procedures provide patients with more options when surgery may not be an option or is higher or at similar risk but a less invasive approach, Dr. Elias explains. As a result, transcather or non-surgical procedures may provide options that would not be available by traditional surgery ameliorating symptoms and in certain cases even extend the lives of more patients who might have had no few treatment options in the past, Dr. Elias says.
“There’s a focus on imaging to tailor procedures for patients who otherwise would not be candidates for any type of therapy because of their surgical risk,” Dr. Elias says. “We’re able to offer therapy to patients, help them avoid difficult surgeries and provide an avenue that really wasn’t there at all even five or 10 years ago.”
Making the Most of Technology
Imaging advances at Miami Cardiac & Vascular Institute include ever-improving 3D scans and fusion imaging, which consists of an echocardiogram overlaid on an X-ray. In addition, the Institute is in the process of acquiring MRI technology that combines with artificial intelligence (AI) to create clearer and faster scans.
“We don’t have the heart open in front of us when we are doing these procedures, so imaging is critical. We have to do this all with intraprocedural guidance — and that guidance is getting better and better,” Dr. Elias says.
Pivotal developments in treating or replacing heart valveshave taken place over the past three decades at Miami Cardiac & Vascular Institute, many of them initiated as part of national clinical trials. The Institute has a robust research program and is frequently at the forefront of technology because of partnerships with medical manufacturers to help develop the next generation of devices.
”We always have all the newer and top-of-the-line tools, which helps us do our job and create better outcomes,” says Dr. Elias, who specializes in preprocedural, intraprocedural and postprocedural imaging for transcatheter structural intervention. “Cardiac imaging continues to evolve as we figure out some of the nuances in a field that constantly is changing based on the new devices available.”
One Clinical Trial of Many
Because of the Institute’s participation in clinical trials and research, patients gain access to treatments and devices before they are widely available, Dr. Elias notes. One example is the TRILUMINATE trial, an international study evaluating a device for patients with severe regurgitation in the tricuspid valve.
Often referred to as the “forgotten valve” because of historically limited treatment options, the tricuspid valve has three leaflets that control the flow of blood between the two chambers on the right side of the heart. When those leaflets do not close properly, blood can flow in the reverse direction — known as regurgitation — forcing the heart to work harder. Left unaddressed, the problem can lead to atrial fibrillation, heart failure and death.
“Currently, there areno approved devices to treat problems on the right side of the heart,” Dr. Elias says. “Usually, patients with this disease are not great surgical candidates because they are too ill. So, if you’re not in the trial, the only treatment options you’re left with are medical management and diuretics.”
The device being evaluated in the TRILUMINATE clinical trial is delivered to the heart via a catheter inserted through the femoral vein in the leg. It works by clipping together a portion of the leaflets of the tricuspid valve to reduce the backflow of blood.
“We’ve enrolled quite a number of patients in this trial,” Dr. Elias says. “We are the only ones offering it in this area. We’ve been fortunate that our patients have access to it, and it’s nice to be able to play a role in such a pivotal trial.”
The research is continuing, but the potential to help people through this treatment is enormous, Dr. Elias says. “I think that it’s going to really reshape the landscape of how we treat that particular valve.”
Lighting a Path to the Future
Emphasis on innovation has been the hallmark of Miami Cardiac & Vascular Institute since its inception 35 years ago. That spirit extends to the collaborative, multidisciplinary approach to providing patients the best of care.
“You want more of a team-based approach where imaging is integrated in every step of the way,” Dr. Elias says. “Volume and expertise are something else that differentiates us. The volume that we do for all these transcatheter procedures, the experience that we have, are important.”
Initially, a lot of the innovation focus was on aortic valve repair, resulting in a minimally invasive procedure called TAVR, or transcatheter aortic valve replacement. Within one decade of the procedure’s approval by the Food & Drug Administration (FDA), it has become the predominant solution for patients with aortic valve problems.
“Now we’re working our way down to the mitral and tricuspid valves, which are more complex. I think in the next five to 10 years we’ll be able to do very similar things, and hopefully with similar outcomes, to avoid surgery when appropriate for those patients,” Dr. Elias says.
“Structural heart interventions continue to evolve because, as we’ve found alternatives to surgery for high-risk patients, the treatments have been so good we can now offer them to intermediate and low-risk patients for certain conditions,” Dr. Elias says. “We now have more options for our patients, as we continue to grow within this field. It’s nice for the patients that we’ll be able to continue to minimize the procedural risk and maximize how fast they can leave the hospital and get back to their lives.”