Health & Fitness

Repairing defective heart valves without open heart surgery

AT BAPTIST HOSPITAL:  Dr. Ramon Quesada, MitraClip expert, works to repair a mitral valve prolapse.
AT BAPTIST HOSPITAL: Dr. Ramon Quesada, MitraClip expert, works to repair a mitral valve prolapse. El Nuevo Herald

Gorky Charpentier walks eight miles, rides a stationary bike, and then spends about an hour exercising in the pool — daily.

He eats well and takes care of himself. So, it’s hard to believe the 75-year-old retired consulate general of Ecuador had a heart operating at less than 30 percent.

Without recent advances in minimally invasive valve procedures, Charpentier probably would have died. And he’s not alone.

For inoperable patients who suffer from mitral valve prolapse and related valve abnormalities, their only option is a minimally invasive procedure — not the usual route of open heart surgery.

High-risk or inoperable patients are typically older, with other health issues or heart conditions, or are smokers.

Mitral valve prolapse is not a disease, Dr. Ramon Quesada said. It’s an abnormality of the tissue of the MVP into the atrium.

In most people, it isn't life-threatening and doesn't require treatment. When the heart’s left atrium and left ventricle don’t close properly, MVP occurs. When the valve fails to close, blood flows backward in the heart — a condition known as mitral valve regurgitation.

Symptoms include shortness of breath, lung congestion and difficulty walking.

“It’s like you’re drowning,” said Quesada, interventional cardiologist at Miami Cardiac & Vascular Institute at Baptist Hospital.

Minimally invasive procedures, like Baptist’s MitraClip, Mount Sinai’s Ring and Sling and University of Miami Miller School of Medicine’s transcatheter aortic valve replacement (TAVR), provide an alternative to surgery for those patients who don’t have the option of open heart surgery.

Baptist Health started the MitraClip trials nearly 10 years ago. Until it received FDA approval in November 2014, Quesada was the only doctor in Florida performing the procedure, which involves implanting a MitraClip into patients by making a puncture in the skin of the groin, and threading a catheter with the clip up to the heart valve through an artery in the leg. The clip then grasps the two leaflets that make up the valve and helps them close.

“It’s one of the most emotionally rewarding procedures because you can immediately see the results. Some patients are better after one day, and some need a couple of days,” he said. “The heart gets stronger within a year.”

For some, one clip is enough. Charpentier needed two MitraClip procedures. His quality of life has improved significantly.

“I’m feeling happy because I’m living in good conditions,” Charpentier said.

Quesada has performed the procedure more than 100 times on patients ranging in age from 41 to 98. He stressed that the nonsurgical option is not a replacement for surgical repair and long-term effects have yet to be seen.

The same goes for Dr. Mauricio Cohen, an interventional cardiologist with the University of Miami Miller School of Medicine. Cohen has been performing transcatheter aortic valve replacements since 2009, when he joined the University of Miami medical school, and said that despite its success, it needs to be tested over time.

“We need to understand the durability of these powerful medical technologies, and we need to assess whether or not we can apply the treatment, not only to high-risk patients likely to do poorly with open-heart surgery, but also to moderate and low-risk patients in whom surgical aortic valve replacement is still the standard of care,” he said. “One day TAVR may replace open-heart surgery, but we are not there yet.”

TAVR is a minimally invasive approach to replacing a failing aortic valve in patients who are not good surgical candidates. Smaller catheters and repositionable valves, which UM is researching, allow for a wider range of patients to be treated in a minimally invasive way — through the groin.

“Before we had these treatments, the only way to treat was open-heart surgery” Cohen said, calling TAVR revolutionary in the treatment of heart valves.

Cohen performed TAVR on 88-year-old Martin Mostovy in June 2014. He had the procedure on a Monday morning, ate a normal dinner that evening and went home that Wednesday. He said the recovery has been amazing.

Age, as well as other significant health issues, made him a poor candidate for surgical aortic valve replacement, so the minimally invasive procedure became a life-saving solution for him.

Bob Hundevadt’s heart was operating at about 35 percent prior to his valve procedure. Hundevadt, director of security for Miami Heat and the AmericanAirlines Arena, left Miami to attend an NBA All-Star weekend with a cold and came back with a cold.

“My wife said, ‘You look like s---t,’” he said. He found his way to Mount Sinai’s chief of cardiac surgery, Dr. Joseph Lamelas.

Lamelas performs the Ring and Sling, a minimally invasive procedure that treats mitral valve insufficiency. He makes a two-inch incision between the ribs on the right side of a patient’s chest. Then, Lamelas separates the ribs without cutting them, takes a tube inside the heart to grab the muscles and pull them together — acting as a ring and sling that strengthen the heart and fix the leak.

Before the procedure, “blood can’t be pumped out effectively,” he said. “These patients are typically very short of breath and fatigued. Most are not just ‘really tired.’”

Recovery is faster than traditional methods of valve replacement or repair. Most surgeons use rings to fix leaky valves or replace them entirely, he said. About 30 percent of patients will come back with a severe valve leak.

“When you use only a ring, you’re not doing anything to the heart muscle,” Lamelas said.

Over the last 20 years, minimally invasive surgeries have become a lot more advanced.

While patients younger than 40 aren’t typically in need of ring and sling procedures, it does happen and minimally invasive techniques are more appealing, aesthetically and otherwise.

“If the valve can be repaired [in younger people], they should have surgery earlier,” Lamelas said.

Nearly a year after his Ring and Sling procedure, Hundevadt, who has high blood pressure, said he feels 98 percent back to normal.

Hundevadt, 57, had mitral valve regurgitation. His heart was enlarged because it was overcompensating for the lack of blood flow. Had he not had the procedure?

“I think I would have probably died.”

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