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A Meeting of the Minds for MR Patients

A new technology and technique bring together cardiologists and heart surgeons to restore quality of life for patients with severe mitral regurgitation (MR) and cannot undergo surgery. The mitral valve is about the size of a 50-cent piece. It is located between the left atrium and the left ventricle, where it works to keep blood flowing through the heart. “Mitral regurgitation occurs when the mitral valve does not close properly,” explains Frances Wood, MD, an interventional cardiologist with WakeMed Heart & Vascular Physicians who specializes in complex heart interventions for heart disease including valve disease and disorders.

“Blood leaks through the mitral valve, causing blood to go back to the lungs instead of effectively pumping through the heart.” MR also produces symptoms that can hinder quality of life. “Shortness of breath, feeling light headed, fatigue, chest pain and swelling in the legs are symptoms of mitral regurgitation,” says Dr. Wood. When left untreated, MR causes congestive heart failure.

Today, nearly 1 in 10 people age 75 and older have either a moderate or severe form of MR. Dr. Wood urges people who have MR to seek treatment before it becomes severe or before they reach advanced age.

“In terms of recovery, there can be a big difference between patients who are age 75 and patients who are 85,” Dr. Wood explains. Mitral valves can often be repaired rather than replaced with open heart surgery. But some patients do not qualify for surgery. MitraClip® technology and the combined expertise of interventional cardiologists and cardiac surgeons may be the answer for some patients who cannot tolerate open surgery.

“It’s a merging of our fields,” says Bryon Boulton, MD, a cardiothoracic surgeon with WakeMed Heart & Vascular Physicians. Dr. Boulton adds that the MitraClip procedure requires the cardiologist to use a more invasive technique than usual and the cardiac surgeon to take a less invasive approach. The ‘merging of the fields’ begins long before the patient enters the procedure room. Together, Dr. Wood and Dr. Boulton meet with a potential patient to determine if a MitraClip is right for them. Dr. Boulton explains that a typical MitraClip candidate:

  • is severely symptomatic of degenerative MR (limited physical activity, fatigue, shortness of breath, palpitations, etc.)
  • is persistent heart failure symptoms despite medical treatment
  • is not suitable for surgery due to age and/or medical conditions (recent heart attack, previous infection in the heart, liver disease, etc.)

The physicians also use a diagnostic tool to determine if an MR patient is suitable for a MitraClip procedure. “An esophageal echo helps us understand the structure of the patient’s heart to determine if we think the procedure is appropriate and where to place the MitraClip,” explains Dr. Wood.

The transthoracic echocardiogram (TEE) and the procedure are performed in the WakeMed Heart Center’s hybrid procedure room, which is a combination of an operating room and a catheterization lab. “Dr. Wood and I then work in concert to perform the procedure,” says Dr. Boulton.

The MitraClip is advanced through a leg vein from the patient’s groin area to the heart. The physician then clips together the leaflets of the valve, creating a smaller opening to prevent blood regurgitation.

“The goal of the MitraClip procedure is to help MR patients enjoy improved quality of life and fewer hospitalizations,” explains Dr. Wood. Dr. Boulton, who is in the nation’s top percentile for open heart mitral valve and aortic valve procedure volumes, sees the minimally invasive approach to heart ‘surgery’ as the wave of the not-too-distant future. “Soon, every modern heart center will have a surgeon who is competent in wire-based procedures,” he says.

Dr. Boulton also sees his collaboration with Dr. Wood and other members of the Heart Center team who work together to correct heart issues as a plus for WakeMed patients. “Our team is positioned to adapt to innovative strategies in the future,” he says.