Less invasive procedure for ‘leaky’ heart valves proves successful
By Alan Mozes
health day reporter
WEDNESDAY, May 24, 2023 (HealthDay News) — When one of the heart’s valves leaks badly, it can cause big problems.
The good news: The condition, known as degenerative mitral regurgitation (DMR), can be treated using a minimally invasive procedure called TEER (transcatheter edge-to-edge repair), a procedure that involves the Insertion of a small clip to allow proper valve closure and blood circulation.
The best news? A new real-world analysis is the first to definitively conclude that the vast majority of patients who undergo the procedure do well afterwards.
This should reassure the more than 2 million Americans who have been diagnosed with DMR.
“Treatment was successful in nearly 9 out of 10 patients in whom TEER was used to repair their mitral valve,” the study’s lead author, Dr. Raj Makkar, said in a statement.
“These strong safety and efficacy results have been validated, despite advanced age and significant comorbidities [other health complications] of these patients,” added Makkar, vice president of cardiovascular innovation and intervention at Cedars-Sinai Medical Center in Los Angeles.
Makkar and his colleagues noted that the average age of the more than 19,000 patients followed by the study team was around 82 years old. All patients had been diagnosed with severe DMR.
According to the American Heart Association (AHA), when a major valve leak occurs, what ends up happening is that each time the left heart chamber contracts, the blood that should then flowing in one direction – from the heart ventricle through the aortic valve – ends up flowing in two directions instead. As a result, the heart has to work harder than normal to pump the same amount of blood, potentially increasing pressure both in the left heart chamber and in the veins that connect the heart to the lungs.
Beyond impairing lung function, if left untreated, severe mitral leakage can ultimately cause the heart to enlarge to such a degree that heart failure develops.
The condition is more common than some might think, noted Makkar, who pointed out that “almost 1 in 10 people over the age of 75 have a leaky valve.”
For many of these patients, open-heart surgery is the standard procedure.
But “there are many elderly patients who are not the best candidates for open-heart surgery,” he warned.
Instead, many of these patients may be better off 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 within 24 hours, with a low risk of in-hospital mortality.
Because the patients in the study were between the ages of 76 and 86, the researchers noted that many struggled with health complications beyond a leaky heart valve.
Accordingly, the study team divided the group of patients into three groups based on the risk of the patient ultimately not surviving the TEER procedure. About 10% were judged to be at low surgical risk, almost 70% were classified as intermediate risk and just over 20% were identified as high risk.
Information about TEER results was extracted from a database maintained by the Society of Thoracic Surgeons and the American College of Cardiology.
A successful TEER result was defined as resulting in a change in leak status from “severe” to “better to moderate,” with no narrowing of the leaky valve. Post-intervention mortality rates were also assessed at three time points: while patients were still hospitalized, and both one month and one year after the intervention.
Ultimately, investigators found that only 2.7% of TEER patients died during the 30-day period.
And in all categories of patients at risk, TEER reduced the severity of valve leaks in more than 95% of patients at 30 days after the procedure.
“The procedure brings many patients back to a more energetic life and to activities that some haven’t been able to do in years,” Makkar said.
Yet his team also observed that over the same 30-day period, a much lower number of patients (67%) ended up with what investigators called a leak status amounting to “mild or less”.
That’s concerning, said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of the preventive cardiology program at UCLA in Los Angeles.
Noting that “there has been relatively little analysis of this procedure in U.S. clinical practice,” Fonarow acknowledged that Makkar’s study suggests that for patients with moderate to severe valve leakage, the procedure “seems be a reasonable treatment option.
But at the same time, he suggested that “there remain other opportunities to improve this procedure,” given the lower number of patients who achieved “light” leak status after TEER.
Fonarow noted that a large randomized trial comparing the relative benefits of other surgical options versus TEER is already underway.
The results were published on May 23 in the Journal of the American Medical Association.
More information
There’s more on 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 Preventative Cardiology Program, and co-chief, division of cardiology, University of California, Los Angeles; Journal of the American Medical Association, May 23, 2023
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