Mending Fragile Hearts with Mitraclip®


 
Mustafa Ahmed, MD in surgery.
When mitral regurgitation begins to burden the heart, surgery can be very successful in repairing a leaky valve.

But how do you help patients whose health is too fragile to risk traditional open heart surgery? Even more difficult, how do you approach cases with multiple valve problems that need to be addressed?

Using MitraClip technology and a team approach, Princeton Baptist Medical Center’s Structural Heart Program is combining the skills of interventional cardiologists, cardiologists and cardiovascular surgeons to improve the quality of life for patients who were running out of options.

“The MitraClip procedure is done transcatheter, which helps limit the trauma to the patient often associated with open heart procedures,” Medical Director of the Structural Heart Program Mustafa Ahmed, MD said. “The technology has been used for several years in Europe. I performed the procedure at a hospital where data was being gathered for FDA approval.

 “When I came to Baptist Princeton, I chose this hospital because of the depth of resources of its heart program,” Ahmed said. “Here in one place, we have both the technologies and the range of skills from multiple heart specialties to deal with more complex cases. “The Heart team approach is critical to our success. Interventionalists and Cardiac surgeons used to be in different worlds, but our approach is blurring the lines because we’re working in tandem. We recently did a procedure that involved Dr. Clifton Lewis making a tiny incision in the patient’s chest. Then I went in with a catheter to fix the valve, and he closed the chest at the end of the procedure.“Another patient we’re working with will involve three total procedures when complete – working on the aortic valve, the mitral valve and the tricuspid valve. The mitral and the aortic valves will be repaired transcatheter. Then Dr Lewis will work on the tricuspid valve robotically. The risk on this patient will be greatly reduced when compared to open heart surgery.”In choosing which patients would be better candidates for the MitraClip procedure, the heart team use a number of criteria including a scoring system that looks at a number of comorbidities like age, lung disease, previous heart surgeries, low function of the heart, diabetes or kidney disease – any combination of which might make a patient high-risk for traditional surgery.

Since FDA approval, momentum for using the MitraClip procedure is growing.

“We’re averaging one to two MitraClips a week now, which is considered high volume,” Ahmed said. “In those not healthy enough for surgery, the procedure might be indicated where there is an enlarged heart or signs of heart failure. Symptoms might include shortness of breath, fatigue, swelling, and symptoms of congestive heart failure. Other indications might include an abnormal heart rhythm or high pressures in the lungs.” Either a problem with the valve or a problem with the heart can lead to the need for mitral valve repair.“If it’s the valve, it wears and tears over time, like a joint in your knee,” Ahmed said. “For instance, if someone has mitral valve prolapse, the fibers that make up the valve weaken over time. Think of it like a parachute. If you cut some of the cords on a parachute, it wouldn’t work the way it’s supposed to, because it’s weaker and the structures holding it together would fail. If the problem is with the heart itself - say the heart is enlarged - the heart keeps getting bigger, but the valve doesn’t, so a gap forms in the middle of the valve and a leak occurs.”The mitral valve is very complex as a structure. There are instances where more than one clip is needed to stop the leaking. The goal is to stop the leakiness without making the valve too tight.“Sometimes two clips are needed, and in rare instances three or more. About 30 percent of our cases involve two clips. We have had great success rates, with 100 percent of patients decreasing the leak from severe, to mild, or less,” Ahmed said.“Almost all our patients went home the next morning. The beauty of the clip is it’s minimally invasive. We explain to patients that there’s always a small chance of complications, but typically we can deal with them. The biggest problem we have is that there are people who are too healthy for the procedure and don't like the thought of open heart surgery. In those cases robotic surgery may be a good option.

Either a problem with the valve or a problem with the heart can lead to the need for mitral valve repair.

 “If it’s the valve, it wears and tears over time, like a joint in your knee,” Ahmed said. “For instance, if someone has mitral valve prolapse, the fibers that make up the valve weaken over time. Think of it like a parachute. If you cut some of the cords on a parachute, it wouldn’t work the way it’s supposed to, because it’s weaker and the structures holding it together would fail. If the problem is with the heart itself - say the heart is enlarged - the heart keeps getting bigger, but the valve doesn’t, so a gap forms in the middle of the valve and a leak occurs.”The mitral valve is very complex as a structure. There are instances where more than one clip is needed to stop the leaking. The goal is to stop the leakiness without making the valve too tight.“Sometimes two clips are needed, and in rare instances three or more. About 30 percent of our cases involve two clips. We have had great success rates, with 100 percent of patients decreasing the leak from severe, to mild, or less,” Ahmed said.“Almost all our patients went home the next morning. The beauty of the clip is it’s minimally invasive. We explain to patients that there’s always a small chance of complications, but typically we can deal with them. The biggest problem we have is that there are people who are too healthy for the procedure and don't like the thought of open heart surgery. In those cases robotic surgery may be a good option.

“Princeton has a robust structural heart and valve program. We’re looking at minimally invasive options for our patients. This approach provides patients with lower risk surgery options, good outcomes, and faster recoveries. Additionally, our patients are experiencing a restoration to their quality of life.”

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