A less invasive procedure for “leaky” heart valves has proven successful
Written by Alan Mozes
Health Day reporter
WEDNESDAY, May 24, 2023 (HealthDay News) — When one of your heart valves develops a large leak, it can mean big trouble.
The good news: A condition known as degenerative mitral regurgitation (DMR) can be treated with a minimally invasive procedure known as TEER (transcatheter edge-to-edge repair), which involves inserting a small clip to allow the valve to fit. occlusion and blood flow.
The better news? A new real-world analysis is the first to definitively conclude that the vast majority of patients who undergo the procedure do well afterward.
This is comforting to the more than 2 million Americans who have been diagnosed with DMR.
“Treatment was successful in almost 9 out of 10 patients who had TEER used to repair their mitral valve,” said Dr. Raj Makkar, lead author of the study.
“These strong safety and efficacy results were validated despite advanced age and significant comorbidities. [other health complications] of these patients,” added Makkar, MD, vice president for cardiovascular innovation and intervention at Cedars-Sinai Medical Center in Los Angeles.
Makkar and colleagues noted that the average age of the more than 19,000 patients followed by the research team was about 82 years. All patients were diagnosed with severe DMR.
According to the American Heart Association (AHA), when a significant valvular leak occurs, what happens is that every time the left ventricle contracts, blood, should then the flow flows in only one direction – from the heart chamber through the aortic valve – and finally in two directions. As a result, the heart has to work harder than normal to pump the same amount of blood, potentially increasing the pressure in both the left ventricle and the veins leading from the heart to the lungs.
In addition to impeding lung function, if severe mitral regurgitation is not treated, the heart can become enlarged to the point of heart failure.
The condition is more common than some people think, noted Makkar, who pointed out that “almost 1 in 10 people over the age of 75 have a leaky valve.”
In many of these patients, open heart surgery is the common procedure.
But “there are many older patients who are not the best candidates for open heart surgery,” he warned.
Instead, many of these patients may do better with a less invasive procedure, such as TEER, in which “the mitral valve is repaired by placing a clip over the leaking part of the mitral valve … Most patients go home in less than 24 hours. , with a low risk of in-hospital death.”
Because the patients in the study ranged in age from 76 to 86, the researchers noted that many were struggling with medical complications beyond the leaky heart valve.
As a result, the study team divided the patient population into three groups based on the risk of the patient not surviving the TEER procedure. About 10% were at low surgical risk, nearly 70% at intermediate risk, and just over 20% at high risk.
Information on TEER results was collected from databases maintained by the Society of Thoracic Surgeons and the American College of Cardiology.
A successful TEER outcome was defined as a change in leakage status from “severe” to “right to moderate” without narrowing of the leaking valve. Post-procedure mortality rates were assessed at three time points: while the patients were still in the hospital, and at one month and one year after the procedure.
Finally, the researchers found that only 2.7% of TEER patients died during the 30-day period.
Across all patient risk categories, TEER reduced the severity of valvular regurgitation in more than 95% of patients 30 days after the procedure.
“The procedure returns many patients to a more energetic life and to activities that some have not been able to do for years,” Makkar said.
Still, his team also observed that over the same 30 days, far fewer patients (67%) ended up with what the investigators described as a “mild or milder” leakage condition.
That’s concerning, said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of the UCLA Preventive Cardiology Program in Los Angeles.
Noting that there has been “relatively little analysis of this procedure in clinical practice in the United States,” Fonarow acknowledged that Makkar’s study suggests that the procedure “seems to be a reasonable treatment option” for patients with moderate to severe valvular regurgitation.
However, he suggested that “there is still room for improvement in this procedure” given the smaller number of patients who achieved a “mild” leak status after TEER.
Fonarow noted that a large randomized trial comparing the relative benefits of other surgical options with TEER is already underway.
The results were published on May 23 Journal of the American Medical Association.
More information
There is more talk about leaky mitral valves at the American Heart Association.
SOURCES: Raj Makkar, MD, associate director, Smidt Heart Institute and vice president, cardiovascular innovation and intervention, Cedars-Sinai Medical Center, Los Angeles; Gregg Fonarow, MD, Director, Ahmanson-UCLA Cardiomyopathy Center, Co-Director, UCLA Preventive Cardiology Program, and Co-Chief, Division of Cardiology, University of California, Los Angeles; Journal of the American Medical Association, May 23, 2023
Source: https://www.webmd.com/heart-disease/news/20230524/large-study-supports-less-invasive-way-to-treat-leaky-heart-valves?src=RSS_PUBLIC
