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Dr. Iyengar on 'Revolutionary' Heart Valve Repair and Replacement

Dr. Iyengar on 'Revolutionary' Heart Valve Repair and Replacement

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, the heart’s inability to pump enough blood.
  • Atrial fibrillation, an irregular heartbeat.
  • Pulmonary hypertension, a type of high blood pressure in your lungs that forces the heart to work harder, increasing the risk for heart-related complications.
  • Death can also be an outcome.

“Fortunately, in the last decade there’s been a revolution — not just an evolution — in repairing and replacing heart valves,” said BCH Structural Heart Program Director Dr. Srini Iyengar during a free online health lecture.

“We now have the capability to address serious internal cardiac issues with minimally invasive techniques. The results with certain procedures are now equivalent to, if not better than, traditional surgical treatment,” he said.

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VIDEO: Watch Dr. Iyengar's online lecture on "Latest Treatments for Heart Valve Problems"
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Please click on the links below to see more info:

Heart Valve Disease: A Problem of Faulty Heart Valves

There are four heart valves that keep blood flowing through the heart and in the proper direction. They are the aortic, mitral, pulmonic and tricuspid valves.

“Heart valve disease occurs when a valve becomes damaged. Although the damage is often linked to age-related factors, sometimes it can develop from illnesses such as rheumatic fever, infective endocarditis or a prior heart attack,” Dr. Iyengar said.

There are two main issues that can occur with the heart’s four 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.

  • Mitral Regurgitation affects thousands of Americans each year, and is the most common type of heart valve insufficiency in the U.S. It occurs when the mitral valve does not fully close, allowing blood to leak backwards. Dr. Iyengar warned, “If you have a mitral regurgitation that starts to progress, it will eventually lead to heart failure. For this reason, it's important to keep a close eye on a diagnosed leaky valve.”
  • Aortic stenosis is the narrowing of the aortic valve that prevents blood flow. It is one of the most serious valve disease problems. Many people who have aortic stenosis live without symptoms for many years. Yet once they start to experience even minor symptoms— angina, shortness of breath, lightheadedness and even fainting—urgent treatment is critical because the disease progresses rapidly.

    “For those with severe aortic stenosis, the survival rate is low when left untreated. Survival is only 50 percent at two years after the onset of symptoms and 20 percent at five years without treatment,” Dr. Iyengar emphasized.

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. While medications can help manage the symptoms, they cannot reverse the underlying disease.

If your condition becomes severe, you may need a valve repair or replacement. “Traditionally this required open-heart surgery, formerly the gold standard treatment,” according to Dr. Iyengar. During an open-heart procedure, patients are connected to a heart-lung bypass machine, which does the work of the heart while their heart is stopped.

However, open-heart surgery becomes riskier with those too frail to endure such an invasive procedure.

“For high-risk patients, a minimally invasive endovascular heart valve repair or replacement can be a safer alternative. These newer 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.”

He added, "Current data now points to patients who are at intermediate or even low risk can get certain procedures to address their underlying valve disease — i.e., aortic stenosis.”

Minimally invasive endovascular valve procedures involve inserting a catheter through a small incision in the upper leg and guiding it through your artery or vein (depending on the type of procedure) — 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 your condition.
• You're a candidate for either open-heart surgery or a minimally invasive endovascular procedure such as MitraClip® Therapy or TAVR.

MitraClip for Mitral Valve Repair

Dr. Iyengar explained that 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 treatments.

The procedure repairs a leaky mitral valve (regurgitation) 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 in mitral regurgitation. The hospital stay is usually just 24 hours,” 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 Food and Drug Administration (FDA) approved only for people with mitral regurgitation for whom surgery is too risky.

TAVR: Newer, Less Invasive Treatment for Aortic Stenosis

An alternative to traditional open-heart valve replacement surgery for severe aortic stenosis 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.

Dr. Iyengar noted on the day of his presentation, “There’s data being released today that indicates, for the first time in U.S. medical history, there are more TAVR procedures being performed for aortic stenosis than open surgical procedures.” He was excited to add, “This technology has surpassed open surgery and is considered the new gold standard for replacing aortic valves with stenosis.”

The 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 not only high-risk but also to low- and intermediate-risk patients.

Click here to view/download a PDF of slides shown during the lecture on “Latest Heart Valve Treatments.”

Make an Appointment

To make an appointment with Dr. Srini Iyengar, or if you have questions about heart valve disease, contact Boulder Heart’s Structural Heart Team at 303-442-2395.

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