by Alan Moses
healthday reporter
WEDNESDAY, May 24, 2023 (HealthDay News) — When a large leak occurs in one of the heart valves, it can cause major problems.
The good news: The condition, known as degenerative mitral regurgitation (DMR), is treatable using a minimally invasive intervention called TER (transcatheter edge-to-edge repair), a procedure that involves repositioning the valve to enable a proper Inserting a small clip is included. closure and blood flow.
better news? A new real-world analysis is the first to definitively conclude that the vast majority of patients who undergo the procedure recover afterward.
That should reassure the more than 2 million Americans who have been diagnosed with DMR.
“The treatment was successful in about 9 out of every 10 patients in whom TER was used to repair their mitral valve,” Dr. Raj Makkar, lead author of the study, said in a statement.
“These strong safety and efficacy results were validated despite advanced age and significant co-morbidities [other health complications] of these patients,” said Makkar, vice president of cardiovascular innovation and interventions at Cedars-Sinai Medical Center in Los Angeles.
Makkar and his colleagues said the average age of the more than 19,000 patients tracked by the study team was about 82 years. All patients were diagnosed with severe DMR.
According to the American Heart Association (AHA), when a major valve leak occurs, what ultimately happens is that each time the left heart chamber contracts, the blood Needed Then flow in only one direction – from the heart ventricle through the aortic valve – instead ends up flowing in two directions. As a result, the heart has to work harder than normal to pump the same amount of blood, potentially increasing the pressure in the left heart chamber and in the veins leading from the heart to the lungs.
Beyond disrupting lung function, if left untreated a severe mitral leak can eventually overstretch the heart to the point that heart failure can develop.
The condition is more common than some might think, said Makkar, who pointed out that “about 1 in 10 people over the age of 75 have a leaky valve.”
For many such patients, open heart surgery is the usual intervention.
But “there are a lot of older patients who are not the best candidates for open heart surgery,” he cautioned.
Instead, many of those patients may do better with a less invasive procedure such as TEER, in which “mitral valve repair is performed by placing a clip over the leaky portion of the mitral valve … most patients recover in less than 24 hours.” I go home.” , with a lower risk of in-hospital mortality.
Because the patients in the study ranged in age from 76 to 86, the investigators noted that many were battling health complications beyond leaky heart valves.
As a result, the study team divided the patient pool into three groups based on the risk that the patient would ultimately not survive the TEER procedure. About 10% faced low surgical risk, about 70% were classified as intermediate risk, and just over 20% were identified as high risk.
Information on TEER results was obtained from databases maintained by the Society of Thoracic Surgeons and the American College of Cardiology.
A successful TEER outcome was defined as a change in leak status from “severe” to “improved-to-moderate” without narrowing of the leaking valve. Post-procedure mortality was also assessed at three time points: while patients were still hospitalized, and one month and one year post-procedure.
Ultimately, the investigators found that only 2.7% of TEER patients died during the 30-day period.
And across all patient risk categories, TEER reduced the severity of valve leak in more than 95% of patients by the 30-day post-procedure mark.
“This procedure is allowing many patients to return to more energetic lives, and return to activities they haven’t been able to do for a few years,” Makkar said.
Nevertheless, his team also observed that by the same 30-day mark a much smaller number of patients (67%) had relapsed with what the investigators described as “mild or low” relapse status.
Dr. Greg Fonaro, director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of the UCLA Preventive Cardiology Program in Los Angeles, said it’s concerning.
Noting that “there has been relatively little analysis of this procedure in US clinical practice,” Fonarow acknowledges that Makkar’s study suggests that for moderate to severe valve leak patients, the procedure is “a reasonable option.” appears to be a treatment option.”
But at the same time, they suggested that “further opportunities remain to improve this procedure”, given the small number of patients who achieved “mild” leak status after TER.
Fonarow notes that TERER, a large randomized trial comparing the relative benefits of other surgery options, is already underway.
The findings were published on May 23 in Journal of the American Medical Association.
more information
The American Heart Association has more about leaky mitral valves.
SOURCES: Raj Makkar, MD, associate director, Smid Heart Institute, and vice president, Cardiovascular Innovation and Intervention, Cedars-Sinai Medical Center, Los Angeles; Greg Fonaro, MD, director, Ahmanson-UCLA Cardiomyopathy Center, co-director, UCLA Preventive Cardiology Program, and co-chief, Department of Cardiology, University of California, Los Angeles; Journal of the American Medical Association, May 23, 2023
