About 5 million people are diagnosed with heart valve disease each year, according to the American Heart Association. The cardiovascular team at Our Lady of Lourdes Medical Center is successfully performing mitral valve repairs using the innovative MitraClip® procedure—a minimally invasive treatment option for people with a severe leak in the mitral valve.
The MitraClip® NT system is the world’s first transcatheter mitral valve repair therapy. It provides a proven treatment option for select patients with significant degenerative MR who are too high-risk for open-heart surgery and do not have other treatment options available to them.
In this fascinating segment, Dr. Atiq Rehman discusses The MitraClip® procedure and how Lourdes Medical Center is leading the way in advancements for valve repair.
Selected Podcast
The Latest Advancements in Mitral Valve Repair; The New MitraClip®
Featured Speaker:
Atiq Rehman, MD
Atiq Rehman, MD, FACS, is the director of Minimally Invasive Cardiac Surgery and the director for Quality and Performance Improvement at Our Lady of Lourdes Medical Center.Transcription:
Melanie Cole (Host): Approximately five million people are diagnosed with heart valve disease each year, according to the American Heart Association. The cardiovascular team at Our Lady of Lourdes Medical Center is successfully performing mitral valve repair using the innovative MitraClip Procedure, a minimally invasive treatment option for people with severe leak in the mitral valve. My guest today is Dr. Atiq Rehman. He is the Director of Minimally Invasive Cardiac Surgery and the Co-director for the Structural Heart Program at Lourdes Health System. Welcome to the show Dr. Rehman. Tell us what has traditionally been done for patients with a severe leak in the mitral valve?
Dr. Atiq Rehman (Guest): So, the traditional treatment for people with severe mitral valve regurgitation or leaking of the mitral valve will be a surgical option which either could be done through a couple of options. One would be a surgical standard operation through a sternotomy. It could be done minimally invasive through a small keyhole incision between the ribs or robotically. That would be the traditional options available for people who have failed medical therapy or who are still symptomatic or going to be symptomatic with severe mitral valve regurgitation.
Melanie: So, this is something that has to have surgical intervention yes, because medication can help relieve symptoms but it does not resolve the situation.
Dr. Rehman: Yes. It has to have – so there are stages of the leakage of the valve. When it becomes severe, there is data accumulated over years to decades that even if patients do not have symptoms as yet, we prophylactically offer them intervention or surgery at that time, especially in centers of excellence. Centers which are doing this as a routine operation with results and complications less than 1-2% complication rate, then we even offer patients who do not have symptoms as yet but are having a severe leakage of the valve then we offer them intervention at that time.
Melanie: So, what’s the latest technique Dr. Rehman, and tell us about the MitraClip Procedure.
Dr. Rehman: So, MitraClip has been in place for almost a decade now. It is a technique which is done nonsurgically in the least invasive manner through a transcatheter approach in which you just make a small access through the vein in the groin like you people have cardiac or heart catheterization. And that is currently available for patients who are considered higher risk for standard mitral valve surgery.
Melanie: So, really, what sets it apart for this transcatheter mitral valve repair? What makes it that much different and benefits for the patient?
Dr. Rehman: Yeah, it is a day and night difference. The patient who will undergo mitral valve surgery whether it is through a standard sternotomy, minimally invasive robotically, it is still open-heart surgery. You are going to be on the heart lung machine. You are going be in the hospital for three to four days and whereas this is a transcatheter based therapy, patients, within 24 hours may be going home. They would not have any scars. They do not have to be on the heart lung machine. They could be transferred to step down units instead of staying in the ICU, so there is a dramatic difference. It is a day and night difference.
Melanie: So are there certain preferred anatomic patient characteristics for this procedure Dr.? Tell us a little bit about patient selection criteria.
Dr. Rehman: Yeah. I think that is a very important point as I mentioned in my previous answer, it is the outcomes or the outlook for this patient is dramatically different and you may even add that those – these patients are sicker, these patients have been turned down for surgical operations and only then they are being referred for this and even with these sicker patients, they are – they could be going home within 24-hours or 48-hours. So, generally, currently commercially available MitraClip is for degenerative mitral valve disease where there is actually something structurally wrong with the mitral or being failed in the mitral valve. The mitral valve can be leaking secondarily because of the frame where the mitral valve lies and that is dilated, that is currently under trial and hopefully by the end of the year, it will have approval for that as well. But regardless, currently, patients who have severe mitral regurgitation and they have been turned down by their surgical consultants for X, Y, Z reasons because of their risk profile, they have hope and they have some way to have their pathology treated in a successful in a very efficient manner.
Melanie: So, tell us a little bit about the MitraClip itself. What’s it made of and what does it look like?
Dr. Rehman: So, honestly, it is a clip. It is a titanium clip with fabric around it and it essentially clips - the mitral valve has two leaflets, like you can imagine a door with one leaflet or two panel doors. So, it is a two-panel valve and you just clip the middle or the area which is leaking the most, those two areas and that keeps it together and it takes on from a surgical technique which has been there for again, decades know as Alfieri Stitch, it was an Italian surgeon and it has taken on from there, but again that is for the operation, this is done through a transcatheter approach and in a high-risk population.
Melanie: So, what is life like for a patient Dr. after they have undergone the MitraClip Therapy Procedure? Can they get back to activities? Are they going to have to be on medications following the procedure? Tell us about recovery.
Dr. Rehman: So, an average – my average mitral valve leakage patient may be treated with medications only and not referred for surgery and there a millions of people out there. So, there are grades of leakage. When they go from mild to moderate to severe, that’s when we offer them surgery. So, if you are having mitral valve leaking and it is mild or moderate, more than likely your cardiologist will be offering you medical therapy. And to the same context, the goal for MitraClip is that if you had severe leakage, and we can bring it down from severe to a grade of ideally to no leakage, even however, even if it is mild to moderate, which can be medically treated, the symptomatology is dramatically different. We have seen people who could not even get out of their bed or just take a few steps and they are walking around the block within 24-hours. And when you look at the echocardiogram they may not have complete resolution of the leakage, but it has gone down to mild. So, that is the goal. The goal is that you may be on some medical – ideally you may not need any medications for the leakage part but you may, but however the idea is to improve the quality of life for that patient and that is the end goal.
Melanie: So, are you using the hybrid OR for this procedure and what is the advantage of that?
Dr. Rehman: So, MitraClip, of course is a transcatheter based therapy, so therefore you may not just do it in the standard operating room, you need fluoroscopy or radiological equipment and that either is available in the cath lab or catheterization lab or in the hybrid operating room where hybrid the term means that it is an operating room with fluoroscopic equipment available as well. So, it could be done either in the cath lab or in the hybrid room.
Melanie: And how long does the clip last Dr.?
Dr. Rehman: Oh, ideally it should last for the patient’s lifetime. I mean these are permanent clips. Of course, nothing is a panacea and clips can migrate or clips can get loose and the patient may need another procedure. However, the incidence of those is I would say less than 5%. If it is placed properly and the results are good and the patient is improving well, then we don’t expect that to happen.
Melanie: So, then wrap it up for us in summary Dr. with your best information about the MitraClip Therapy Procedure for severe mitral valve leakage, what you want patients to know about the option for this if they might be a candidate.
Dr. Rehman: I would say MitraClip is a lifechanging procedure for patients who have severe leakage of the mitral valve and who have been turned down or been told that they are not surgical candidates. I think it offers them hope and a choice for a better quality of life and it can be done in an efficient and the least invasive manner and the results are dramatic.
Melanie: Thank you so much Dr. for being with us today. You are listening to Lourdes Health Talk and for more information you can go to lourdesnet.org. That’s lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Approximately five million people are diagnosed with heart valve disease each year, according to the American Heart Association. The cardiovascular team at Our Lady of Lourdes Medical Center is successfully performing mitral valve repair using the innovative MitraClip Procedure, a minimally invasive treatment option for people with severe leak in the mitral valve. My guest today is Dr. Atiq Rehman. He is the Director of Minimally Invasive Cardiac Surgery and the Co-director for the Structural Heart Program at Lourdes Health System. Welcome to the show Dr. Rehman. Tell us what has traditionally been done for patients with a severe leak in the mitral valve?
Dr. Atiq Rehman (Guest): So, the traditional treatment for people with severe mitral valve regurgitation or leaking of the mitral valve will be a surgical option which either could be done through a couple of options. One would be a surgical standard operation through a sternotomy. It could be done minimally invasive through a small keyhole incision between the ribs or robotically. That would be the traditional options available for people who have failed medical therapy or who are still symptomatic or going to be symptomatic with severe mitral valve regurgitation.
Melanie: So, this is something that has to have surgical intervention yes, because medication can help relieve symptoms but it does not resolve the situation.
Dr. Rehman: Yes. It has to have – so there are stages of the leakage of the valve. When it becomes severe, there is data accumulated over years to decades that even if patients do not have symptoms as yet, we prophylactically offer them intervention or surgery at that time, especially in centers of excellence. Centers which are doing this as a routine operation with results and complications less than 1-2% complication rate, then we even offer patients who do not have symptoms as yet but are having a severe leakage of the valve then we offer them intervention at that time.
Melanie: So, what’s the latest technique Dr. Rehman, and tell us about the MitraClip Procedure.
Dr. Rehman: So, MitraClip has been in place for almost a decade now. It is a technique which is done nonsurgically in the least invasive manner through a transcatheter approach in which you just make a small access through the vein in the groin like you people have cardiac or heart catheterization. And that is currently available for patients who are considered higher risk for standard mitral valve surgery.
Melanie: So, really, what sets it apart for this transcatheter mitral valve repair? What makes it that much different and benefits for the patient?
Dr. Rehman: Yeah, it is a day and night difference. The patient who will undergo mitral valve surgery whether it is through a standard sternotomy, minimally invasive robotically, it is still open-heart surgery. You are going to be on the heart lung machine. You are going be in the hospital for three to four days and whereas this is a transcatheter based therapy, patients, within 24 hours may be going home. They would not have any scars. They do not have to be on the heart lung machine. They could be transferred to step down units instead of staying in the ICU, so there is a dramatic difference. It is a day and night difference.
Melanie: So are there certain preferred anatomic patient characteristics for this procedure Dr.? Tell us a little bit about patient selection criteria.
Dr. Rehman: Yeah. I think that is a very important point as I mentioned in my previous answer, it is the outcomes or the outlook for this patient is dramatically different and you may even add that those – these patients are sicker, these patients have been turned down for surgical operations and only then they are being referred for this and even with these sicker patients, they are – they could be going home within 24-hours or 48-hours. So, generally, currently commercially available MitraClip is for degenerative mitral valve disease where there is actually something structurally wrong with the mitral or being failed in the mitral valve. The mitral valve can be leaking secondarily because of the frame where the mitral valve lies and that is dilated, that is currently under trial and hopefully by the end of the year, it will have approval for that as well. But regardless, currently, patients who have severe mitral regurgitation and they have been turned down by their surgical consultants for X, Y, Z reasons because of their risk profile, they have hope and they have some way to have their pathology treated in a successful in a very efficient manner.
Melanie: So, tell us a little bit about the MitraClip itself. What’s it made of and what does it look like?
Dr. Rehman: So, honestly, it is a clip. It is a titanium clip with fabric around it and it essentially clips - the mitral valve has two leaflets, like you can imagine a door with one leaflet or two panel doors. So, it is a two-panel valve and you just clip the middle or the area which is leaking the most, those two areas and that keeps it together and it takes on from a surgical technique which has been there for again, decades know as Alfieri Stitch, it was an Italian surgeon and it has taken on from there, but again that is for the operation, this is done through a transcatheter approach and in a high-risk population.
Melanie: So, what is life like for a patient Dr. after they have undergone the MitraClip Therapy Procedure? Can they get back to activities? Are they going to have to be on medications following the procedure? Tell us about recovery.
Dr. Rehman: So, an average – my average mitral valve leakage patient may be treated with medications only and not referred for surgery and there a millions of people out there. So, there are grades of leakage. When they go from mild to moderate to severe, that’s when we offer them surgery. So, if you are having mitral valve leaking and it is mild or moderate, more than likely your cardiologist will be offering you medical therapy. And to the same context, the goal for MitraClip is that if you had severe leakage, and we can bring it down from severe to a grade of ideally to no leakage, even however, even if it is mild to moderate, which can be medically treated, the symptomatology is dramatically different. We have seen people who could not even get out of their bed or just take a few steps and they are walking around the block within 24-hours. And when you look at the echocardiogram they may not have complete resolution of the leakage, but it has gone down to mild. So, that is the goal. The goal is that you may be on some medical – ideally you may not need any medications for the leakage part but you may, but however the idea is to improve the quality of life for that patient and that is the end goal.
Melanie: So, are you using the hybrid OR for this procedure and what is the advantage of that?
Dr. Rehman: So, MitraClip, of course is a transcatheter based therapy, so therefore you may not just do it in the standard operating room, you need fluoroscopy or radiological equipment and that either is available in the cath lab or catheterization lab or in the hybrid operating room where hybrid the term means that it is an operating room with fluoroscopic equipment available as well. So, it could be done either in the cath lab or in the hybrid room.
Melanie: And how long does the clip last Dr.?
Dr. Rehman: Oh, ideally it should last for the patient’s lifetime. I mean these are permanent clips. Of course, nothing is a panacea and clips can migrate or clips can get loose and the patient may need another procedure. However, the incidence of those is I would say less than 5%. If it is placed properly and the results are good and the patient is improving well, then we don’t expect that to happen.
Melanie: So, then wrap it up for us in summary Dr. with your best information about the MitraClip Therapy Procedure for severe mitral valve leakage, what you want patients to know about the option for this if they might be a candidate.
Dr. Rehman: I would say MitraClip is a lifechanging procedure for patients who have severe leakage of the mitral valve and who have been turned down or been told that they are not surgical candidates. I think it offers them hope and a choice for a better quality of life and it can be done in an efficient and the least invasive manner and the results are dramatic.
Melanie: Thank you so much Dr. for being with us today. You are listening to Lourdes Health Talk and for more information you can go to lourdesnet.org. That’s lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
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