Over the last four decades, there has been a tremendous reduction in mortality of patients with cardiovascular diseases. This applies to the entire spectrum of disease, including patients with acute myocardial infarction, heart failure, atrial fibrillation and arrhythmia.
We have also benefited from a number of novel technologies that have allowed the repair and replacement of heart valves such as the mitral, aortic, tricuspid and pulmonary valves.
Carefully selected patients can undergo a routine procedure with transcatheter heart valve systems, and recovery time is usually within 24 hours. These services include transcatheter aortic valve replacement; MitraClip for patients with mitral regurgitation; transcatheter tricuspid valve repair; and soon Tricuspid replacement and Mitral replacement, as well as atrial appendage closure.
Transcatheter mitral valve repair is a minimally invasive procedure that may be an option for patients with degenerative mitral regurgitation and functional mitral regurgitation who are too sick for surgery. Unlike surgery, this procedure does not require opening the chest and temporarily stopping the heart. Made from metal and polyester, the MitraClip is designed to relieve symptoms of mitral regurgitation and prevent hospitalization for heart failure.
During this procedure, a small 8 mm opening is made in the femoral vein, and a guide wire and catheter is threaded toward the heart. This is gradually moved into the left atrium. The guide wire is then removed and the clip is eased through the catheter and into the atrium. Once in place, the MitraClip’s arms are opened and placed over the leaflets. Next, the arms are closed and surgeons clip the leaflets together creating two smaller channels that prevent the backflow of blood. When the procedure is completed, the catheter is removed, but the MitraClip is left in place. Patients are typically discharged within a day or two after the procedure and experience an improvement in symptoms immediately following the procedure.
Recent research has found that catheter-based mitral repair is also beneficial for patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation, or functional mitral regurgitation, who remain symptomatic despite the use of maximal doses of guideline-directed medical therapy (COAPT ClinicalTrials.gov). Based on this research, CMS approved MitraClip for use in functional mitral regurgitation patients, which has enabled providers to offer this as a treatment option for this patient population. Therefore, MitraClip reduces mortality and HF admission while it improves quality of life.
Mohommad Sarraf, MD is an Interventional Cardiologist who services as Director of the Structural Heart Program at Princeton Baptist Medical Center.
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