#2 Expanded Use of Minimally Invasive Mitral Valve Surgery

Overview

The news is heavy – your heart has malfunctioned, and you’ll need a surgery. Your thoughts swirl as the diagnosis sounds severe. You’ll need to prep for a major surgery, and will need weeks or months to recover. But as your surgeon explains, your spirits lift. There’s an easy fix for the mitral valve you need repaired, and you’re now eligible for the surgery. Though the situation is still unnerving, you are grateful to hear that last year, your course of treatment would’ve be very different and less ideal.

The mitral valve is a valve in the heart that lets blood flow from one chamber to another – specifically from the left atrium to the left ventricle. But in about 1 in 10 individuals over the age of 75, this mitral valve is defective causing the action of regurgitation. Mitral valve regurgitation, or mitral regurgitation (MR), is a condition in which blood leaks backward through the opening of the mitral valve into the left atrium. MR places extra burden on the heart and lungs, causing the heart to work harder to function normally. With MR, one might experience fatigue or inability to exercise, shortness of breath, fainting, and swollen legs and feet. Over time, some people with MR may develop an enlarged heart due to the strain placed on it. If left untreated, MR can cause other, more serious heart problems.
There are several kinds of mitral regurgitation that one might suffer from. Patients with significant MR and heart failure symptoms resulting from abnormalities of the mitral valve are diagnosed with primary or degenerative MR, while individuals with heart failure symptoms and moderate-to-severe or severe MR due to diminished left heart function are diagnosed with secondary or functional MR. Primary or degenerative MR is often due to age, birth defect, or underlying heart disease, while secondary or functional MR is a result of heart disease that has led to an enlarged left ventricle. Based on subtype of the condition, treatments for the problem vary.

Minimally invasive surgery for mitral valve repair came online in October 2013. This new, transcatheter, device to treat MR revolutionized the cardiac industry, allowing patients a less invasive solution for their regurgitation. Until now, the innovative device was only approved to treat mitral valve regurgitation in individuals with primary or degenerative MR who were not eligible for open-heart surgery. But for those considered low risk for mitral valve surgery, either medical therapy prescription, or a more traditional, more invasive approach was taken.

But in March 2019, the FDA approval was expanded to include use in individuals with secondary or functional MR, despite optimal medical therapy. Expanding the approval of the device to this population of patients who have failed to get symptom relief from other therapies provides an important new treatment option. This expanded use of the minimally invasive method is removing some risk, fear, and inconvenience from the cardiac surgery equation.

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