Thursday, March 25, 2021
Study results offer hope to patients with functional mitral regurgitation
Beaumont Health, a leader in the nonsurgical treatment of mitral valve disease, is now offering treatment for certain patients with a leaky mitral valve due to an enlarged or weakened heart - patients who had few options, until now.
Joyce Smith, 69, of Detroit, said her symptoms improved greatly after the implantation of a MitraClip on March 5, 2021, to treat her mitral valve disease. Beaumont Interventional Cardiologist Dr. Ivan Hanson used the MitraClip to avoid open heart surgery under new guidelines aimed specifically at patients like Joyce.
“Beaumont is grateful to offer these advanced procedures for the treatment of cardiovascular valve disease,” said Dr. Simon Dixon, the Dorothy Susan Timmis Endowed Chair of Cardiology at Beaumont Hospital, Royal Oak, and a national expert in interventional cardiology. “As a leader in the Midwest in these types of treatments, we work with cardiologists throughout the region to offer these alternatives to their patients. The patients often don’t realize there are options available.”
Joyce had heart bypass surgery nearly 30 years ago, when she was 41. She was working as a Family Independence Specialist for the State of Michigan, helping those in need navigate programs offered through the Department of Health and Human Services. She first noticed shortness of breath while moving snow along the side of her house on Detroit’s west side.
She felt great after the bypass, watching her salt intake and eating right, scheduling regular checkups with a cardiologist. But she started noticing a “stuffy feeling in her sinuses” around 2019, which her doctors attributed to allergies or the common cold.
But in March 2020, just before COVID-19 hit Michigan, her daughter took her to the Beaumont, Royal Oak Emergency Center when that stuffy feeling progressed to an inability to breathe. Her ongoing heart disease was causing her mitral valve to malfunction. Joyce needed help. Dr. Mark Goldberg, her longtime personal cardiologist, referred her to the valve experts at Beaumont.
The mitral valve, one of the heart’s four valves, controls blood flow from the left atrium to the left ventricle. But when the valve’s flaps, or leaflets, malfunction, blood can backflow into the left atrium and lungs, causing what is called “regurgitation.” This malfunction can cause the heart to work harder, leading to issues such as heart failure or irregular heartbeat, a condition known as atrial fibrillation or AFib.
Malfunction of the flaps of the mitral valve due to damage of the leaflets or support structures is called degenerative mitral valve regurgitation, or degenerative MR, and is often caused by age, heart disease or birth defects. But when a heart attack or heart failure causes the heart to enlarge or change shape, like in Joyce’s case, the flaps of the mitral valve no longer come together when the heart beats, creating functional mitral valve regurgitation, or functional MR.
MitraClip is the only FDA-approved device for transcatheter edge-to-edge repair (TEER) of the mitral valve. While this procedure option was previously limited to only a small subset of patients with degenerative MR, more recent data from the COAPT trial is changing that paradigm. Beaumont Health was one of 86 COAPT trial sites in the United States and one of only three sites in Michigan. The trial revealed that appropriately selected patients with functional MR have better outcomes with MitraClip compared to the usual standard of care.
“Less than 2% of those with severe functional mitral regurgitation are being treated,” said Dr. Hanson. “There are several reasons for this. First, many patients with weak hearts are often not good candidates for open heart surgery. Second, until COAPT, we had no convincing data that mitral valve intervention (surgical or cathteter-based) helped patients with functional MR. Finally, few centers have enough volume of cases and procedural expertise to be able achieve reliable results with MitraClip. We at Beaumont are very pleased to offer this option to our patients, some whose lives have been greatly impacted by functional MR and its associated debilitating symptoms.”
The MitraClip procedure involves two cardiologists, one to image the valve with an ultrasound probe placed in the esophagus, and another to maneuver the device from the groin into the heart and onto the mitral valve. The MitraClip pinches together the leaflets of the valve, which improves the seal in the valve and prevents backflow of blood into the lungs. The procedure does not involve open heart surgery - rather, only a couple of tiny incisions to gain access to the vessels in the groin.
Ms. Smith’s MitraClip procedure took about two hours at Beaumont, Royal Oak on March 5, 2021.
“I felt good after the procedure; I felt wonderful,” said Ms. Smith, whose procedure yielded immediate results. “I haven’t had any stuffy feeling; my sinuses have been clear.”
Dr. Hanson said patients typically notice an immediate change in their ability to breathe, move around and function in their daily lives.
Joyce said she’s looking forward to planting begonias – orange are her favorite – outside her home a few blocks down from Marygrove College on Detroit’s west side.
“Oh I plant flats of them,” she said, smiling at the thought of getting back to gardening. “You have to, to make them look good.”