Important development in heart valve surgery
More patients with leaking heart valves can be treated using a metal device called a Mitraclip, which was formerly only used for uncomplicated heart valve leakage. An international team of researchers has shown that the method can also be used for more advanced valve diseases, which means that a larger number of patients who previously had no treatment option can now be helped.
The clinical study was carried out by researchers at Karolinska Institutet and Karolinska University Hospital and their colleagues in Denmark and Britain, and is published in the science periodical Journal of the American College of Cardiology (JACC). Leakage at the heart valve between the left auricle and ventricle - what is known as mitral insufficiency - is a common disorder. The risk of it developing increases with age, so that approximately one in ten people over the age of 75 have moderate to advanced mitral valve disease. At present, advanced symptomatic valve leakage is usually treated through conventional heart surgery, whereby the chest is opened for the valve to be either repaired or replaced. Studies have shown that half of the patients with pronounced mitral insufficiency who do not undergo surgery die within five years. Despite this, and because heart surgery is considered too risky, only 50 per cent or so of these patients are treated in this way.
The Mitraclip method, which involves inserting the tiny device through a vein in the groin and into the heart, means that the valve can be repaired without having to open the chest. It has proved to be safer, although less effective, than conventional heart surgery, but has been mainly restricted to patients for whom the latter is deemed too dangerous and, until now, has only been indicated when the leakage occurs at the centre of the valve. In consequence, a large number of patients have not been able to receive treatment.
In a study of 173 heart patients, the researchers have now been able to demonstrate that the Mitraclip can also be used when the leakage is not central, and for other more advanced valve pathologies that have previously been considered contraindicated for the procedure.
"Our results mean that patients who once had no treatment option can now be treated, with the subsequent improvements in symptoms and life quality," says research team member Dr Magnus Settergren at the Department of Medicine, Solna, also a Consultant at Karolinska University Hospital's cardiology clinic.
The study was conducted without external financing and independently of the company behind the MitraClip brand.
Echocardiographic and clinical outcomes of central versus noncentral percutaneous edge-to-edge repair of degenerative mitral regurgitation.
J. Am. Coll. Cardiol. 2013 Dec;62(25):2370-2377