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A new fix for ‘leaky’ heart valves drastically cuts patient recovery time

March 2016 

 

For decades, doctors treating patients with a certain type of “leaky” heart valve had a standard playbook: open heart surgery. That typically meant a hospital stay of a week or more before patients could get back on their feet.

A new, minimally invasive procedure can cut that recovery down to a single day.

It’s called MitraClip Transcatheter Mitral Valve Repair therapy. MitraClip is a non-surgical way to repair a leaky mitral valve, one of the four valves in your heart. A small leak doesn’t cause too much of a problem, but a larger leak results in blood backing up into your lungs and eventually will cause heart failure.

The MitraClip technique was first pioneered in 2003 and approved by the FDA in October 2013. Since then, a multidisciplinary team at UW Medicine Regional Heart Center has performed the procedure more than 100 times, making it one of the top five sites in the U.S. to provide the therapy.

Patients typically leave the hospital the next day or shortly thereafter. Compared with a weeklong stay after open heart surgery, recovery times after MitraClip are extraordinary, said Liz Perpetua, an adult and acute care nurse practitioner and director of Structural Heart Services. She recalled one elderly patient, previously laid low by her disorder, get back on her tractor soon after her discharge. “It’s incredible to see patients immediately get back to doing the things they love,” she said.

A leaky mitral valve – called mitral regurgitation – can be found in more than 2 million people in the U.S. Symptoms can include shortness of breath, fatigue and heart palpitations. In mild cases, the disorder can be treated with medicine. But in severe cases the valve needs to be repaired or replaced.

Enter the MitraClip. During the procedure, doctors make a small incision in the patient’s groin, then advance the clip through a catheter. It’s pushed upwards to the heart. Meanwhile, an imaging specialist provides 3D echocardiographic views of the clip’s position and the valve, allowing the cardiologist to clip together a small area of the valve leaflets. That brings the leaflets closer together, reduces the leak in the valve and allows blood to flow forward on both sides of the clip.

Dr. Mark Reisman, head of Interventional Cardiology, credits the vast improvements in imaging technology with the procedure’s high success and safety rates. In the OR, he stands shoulder-to-shoulder with Dr. G. Burkhard Mackensen, chief of cardiothoracic anesthesiology, who supplies 3D ultrasound images, or echocardiograms, to help guide the clip. “Without them, the procedure can be like driving a car without lights. But with these exquisite images, it’s like someone flicked on the headlights.”

Today, the MitraClip procedure is only performed on patients who are at prohibitive risk for open heart surgery, Dr. Reisman said. But one day, the bulk of valve repair may be catheter-based – which ultimately will not only result in reduced hospital stays and overall cost but also in improved outcomes. 

Learn more about UW Medicine Regional Heart Center.

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