People with mild heart valve problems often live long, full lives and never
require treatment. But once a diseased valve begins to affect your heart’s
ability to pump blood, you may need a valve repair or replacement to prevent
serious complications such as congestive heart failure, atrial fibrillation,
pulmonary hypertension or even death.
“Fortunately, in the last decade there’s been a revolution
— not just an evolution — in repairing or replacing heart
valves,” said BCH structural heart program director
Dr. Srini Iyengar during a free health lecture.
“We now have the capability to address serious internal cardiac issues
with minimally invasive techniques. The results with certain procedures
have shown to be equivalent to, if not better than, traditional surgical
treatment,” he said.
Heart Valve Disease: A Problem of Faulty Heart Valves
The heart has four heart valves that control blood flow into and through
the heart. They are the aortic, mitral, pulmonic and tricuspid valves.
“Heart valve disease occurs when a valve becomes damaged, leading
to a backflow of blood or complete blockage of blood flow. Although problems
with heart valves are often linked to age-related factors, sometimes they
can develop from illnesses such as rheumatic fever or infective endocarditis,”
Dr. Iyengar said.
Two main problems can occur with these valves: regurgitation and stenosis.
Regurgitation occurs when a valve does not fully close and allows blood
to leak backwards. This is commonly referred to as a leaky valve. Stenosis
is the narrowing of a valve that prevents blood flow. It is often described
as a tightening valve.
Any of the four valves can have regurgitation or stenosis—sometimes
both—but the mitral and aortic valves are most likely to be damaged.
Minimally Invasive Endovascular Valve Repair or Replacement
Treatment for mitral or aortic valve disease depends on the severity of
the damage and may include prescribed medication. However, medications
can only help manage the symptoms and cannot reverse the underlying problem.
If your condition becomes severe, you may need a valve repair or replacement.
Usually this requires open-heart surgery, the gold standard treatment,
according to Dr. Iyengar. During this procedure, patients are connected
to a heart-lung bypass machine, which does the work of the heart while
their heart is stopped.
Yet open-heart surgery becomes riskier with those too frail to endure such
an invasive procedure.
“For these high-risk patients a minimally invasive endovascular procedure
can be a safer alternative. These new procedures don’t require opening
up your chest or being placed on a heart-lung machine,” said Dr.
Iyengar. “They can also result in reduced scarring, less postoperative
pain and a shorter recovery time, when compared to open heart surgery.”
Endovascular valve repair or replacement procedures involve inserting a
catheter through a small incision in the upper leg and guiding it through
your vein—via fluoroscopy (special x-ray) and echocardiography (type
of ultrasound)—to reach the heart.
Your doctor will determine whether:
• Mitral valve repair or replacement is the most appropriate for
• You're a candidate for either open-heart surgery or a minimally
invasive endovascular procedure such as
MitraClip® Therapy or
MitraClip for Mitral Valve Repair
Dr. Iyengar explained how Boulder Community Health’s full-service
cardiology program—the only one in Boulder County—recently
added MitraClip® Therapy to its range of minimally invasive endovascular
The procedure repairs a leaky mitral valve by using a small, dime-sized
clip to close the center of the valve. The physician guides the clip through
a large vein in your leg to your heart via a steerable catheter, which
delivers and attaches the device to the mitral valve. Once the clip is
attached, your mitral valve closes more completely, helping to restore
normal blood flow through your heart.
“Clinical data from patients who underwent the MitraClip procedure
demonstrate an immediate reduction of mitral regurgitation and a low hospital
length of stay of just 2.9 days,” Dr. Iyengar said.
He added, “Patients who were studied one year after the procedure
continued to experience improvement in their quality of life. And, there
was a 73 percent reduction in hospitalizations for heart failure in the
year following the procedure compared to the year prior.”
MitraClip Therapy is FDA approved only for people with mitral regurgitation
for whom surgery is too risky.
TAVR: Newer, Less Invasive Treatment for Aortic Stenosis
Many people who have aortic stenosis live without symptoms for many years.
Yet once they start to experience even minor symptoms, urgent treatment
is critical. The disease progresses rapidly, and when it becomes severe
the prognosis is poor.
“For those with severe aortic stenosis, the survival rate is low
when left untreated. Half of those who develop aortic valve stenosis die
within two years after the onset of symptoms and 20 percent at five years
without treatment,” Dr. Iyengar told the audience. “However,
studies show getting an artificial heart valve lowers that death rate
to as low as 17 percent.”
An alternative to traditional open-heart valve replacement surgery is a
new, less invasive endovascular option called Transcatheter Aortic Valve
Replacement (TAVR). The procedure involves replacing the faulty valve
by threading a synthetic one through a blood vessel.
The U.S. Food and Drug Administration (FDA) recently expanded the number
of patients diagnosed with severe aortic stenosis who will be able to
receive TAVR. It opened use of TAVR to low-risk patients.
To make an appointment with
Dr. Srini Iyengar, or if you have further questions about heart valve disease, contact Boulder
Heart’s Structural Heart Team at 303-442-2395.
PowerPoint slides from Dr. Iyengar’s lecture on “Latest Heart Valve Treatments.”
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