UMMC First in State to Offer Mitral Valve Repair Without Surgery

This article is a part of University of Maryland Rounds, which features clinical and research updates from the University of Maryland School of Medicine and University of Maryland Medical Center. See more Rounds articles.

On the heels of federal approval for a minimally invasive approach to repair leaky mitral heart valves, University of Maryland Medical Center (UMMC) has become the first hospital in the state to offer the innovative MitraClip procedure to severely affected patients who aren't eligible candidates for conventional open-heart surgery.

Incorporating a team approach that includes cardiac surgeons, interventional cardiologists, cardiac anesthesiologists and echocardiography specialists, UMMC began performing the catheter-based MitraClip procedure in January 2014. While the therapy has been clinically tested for years at selected centers around the nation, the FDA only recently sanctioned the procedure for patients with serious mitral valve leakage whose co-existing medical conditions — such as kidney failure, previous heart surgery or advanced age — make them too high-risk for traditional surgery to repair or replace the mitral valve.

Mitral valve leakage, known as "regurgitation," occurs when the leaflets of the heart's mitral valve don't close tightly as the heart beats to push blood out to the body. This leak allows some of the blood to flow backward from the left ventricle to the left atrium.

Valve Leakage Can Trigger Critical Problems

"Several conditions can cause a leak to develop in the valve, essentially forcing the heart to pump 10 gallons of blood just to get five gallons to move forward," explains James Gammie, MD, chief of cardiac surgery and co-director of the University of Maryland Heart Center. "The leaking valve directs backward flowing blood towards the lungs, leaving patients feeling very short of breath and fatigued," says Mark Vesely, MD, assistant professor of medicine at the UM School of Medicine and director of the Interventional Cardiology fellowship training program.

"Left untreated, mitral valve regurgitation can eventually trigger rhythm problems such as atrial fibrillation and weakening of the heart pump, resulting in heart failure and death," adds Dr. Gammie, who is also a professor of surgery at University of Maryland School of Medicine.

About 60,000 Americans undergo conventional open-heart surgery each year to replace or repair their malfunctioning mitral valve. So far, only a small percentage of those patients receive the MitraClip instead. "It's exciting because it's the first catheter-based technology that allows us to repair the mitral valve without open-heart surgery," says Dr. Gammie.

Procedure Offers Quick Recovery

As a minimally invasive procedure, a short hospital stay — two to five days, compared to seven to 10 days with conventional valve surgery — is among the procedure's many benefits. Patients also don't typically need a stay in a rehabilitation facility afterward.

Drs. Gammie and Vesely work side by side to place the MitraClip. Through a small incision in the groin, a catheter is passed up a vein to the heart. The metal clip is delivered through the catheter and positioned between the mitral valve's two leaflets, where the device is locked in place. The clip creates a tighter seal between the leaflets to limit backward flow but allow blood to flow forward through the valve. "We have seen remarkable improvements in shortness of breath and overall quality of life with this procedure," exclaims Dr. Vesely. "And patients can also expect to be in the hospital for heart failure far less often."

But according to Dr. Gammie, the MitraClip technology is still considered less effective than open-heart surgery to repair or replace the valve. "Traditional mitral valve repair surgery is a pretty good operation and can be done with a very low risk of death and a high likelihood of repair, particularly if done by experienced mitral valve surgeons," he says. "For a substantial majority of patients, conventional surgery remains the best option right now. The MitraClip procedure extends our ability to treat those patients who otherwise wouldn't be able to have that surgery. In the end, it will be one tool in our tool box to treat mitral regurgitation."

"It's a great option, because it's a terrible feeling to be short of breath," Dr. Gammie adds. "When that happens all the time, it contributes to a miserable quality of life. So it's a privilege to help patients with the MitraClip."

To reach Dr. Gammie, Dr. Vesely and the University of Maryland Heart Center, please call 410-328-2583 (410-32-VALVE).