New Valve Procedure Offers Hope to Older Heart Disease Patients

January 21, 2015

What a difference a year makes. Patricia Lytton recalls how much better her health is today compared to a year ago thanks to a new valve procedure offered at Wake Forest Baptist Medical Center.

Lytton just wanted to be home in time to celebrate her 77th birthday with her family. But when she first went into the hospital two months earlier for congestive heart failure she wasn’t sure she would ever reach that milestone.

Lytton first experienced problems in 2012, but nothing like the symptoms that stopped her in her tracks one January night last year at her home in Statesville. She couldn’t breathe. Paramedics arrived and she was stabilized at her local hospital.

Once transferred to Wake Forest Baptist, tests revealed Lytton’s mitral valve was not functioning properly. She was experiencing mitral regurgitation (MR), one of the most common types of heart valve disease in the United States.

MR occurs when blood flows back into the left atrium of the heart instead of out into the left ventricle and to the rest of the body. It causes the heart to work harder and was the reason behind Lytton’s fatigue, shortness of breath and worsening heart condition.

The question remained how to repair her mitral valve. The options include treating the symptoms, which had been the case prior to Lytton’s arrival, open heart surgery or transcatheter mitral valve repair (TMVR).

Lytton feared open heart surgery. She worried her age and strength would not get her through the surgery. She prayed for another option, but she feared there wasn’t one.

“They did tests and told me I was not a candidate for open heart surgery,” she said. “I thought, well, if I’m not a candidate for open heart surgery what does that mean. Does that mean I’m going to die?”

The answer to Lytton’s prayer existed in TMVR. That’s when David Zhao, M.D., chief of cardiovascular medicine at Wake Forest Baptist Medical Center, told her about the TMVR device known as MitraClip. Other TMVR devices are in development, but MitraClip is the only FDA-approved TMVR device at this time.

Patients must meet certain health conditions to qualify for TMVR. Surgery is the preferred procedure to correct MR. TMVR is for patients who are more at risk for complications from surgery.

The TMVR procedure involves inserting a device that is threaded on a catheter through an incision in the groin, into a vein that leads to the left chambers of the heart. Inside the heart, a small high-tech clip is attached that holds together a portion of the mitral valve leaflets. The clip helps the valve close without allowing MR or blood flow back into the heart chamber.

“MitraClip gives our patients an option that they didn’t have before,” said Zhao. “Many of these patients have multiple chronic conditions and are not candidates for open heart surgery to fix their mitral valve. This procedure allows us to restore their valve without open heart surgery and leads to improved heart function and a quicker recovery time.”

Wake Forest Baptist is the only medical center in the Triad offering the MitraClip TMVR procedure for patients with degenerative MR and is one of 10 additional sites in the country selected to participate in the COAPT clinical trial. The trial will study the use of MitraClip in patients with functional MR, where the mitral valve can’t close because of a change in the size of the patient’s heart after heart failure.

Zhao, Sanjay Gandhi, M.D., Min Pu, M.D., and Bharathi Upadhya, M.D., in collaboration with Wake Forest Baptist cardiothoracic surgeons and cardiac anesthesiologists performed their first TMVR procedure in Aprilof last year and have done 15 more since then in patients 71 to 88 years old. The results to date have shown positive outcomes from the procedure including Lytton’s.

“Oh, it’s given me a new outlook on life,” she said. “I feel like I can see my grandchildren grow, and my great grandchildren grow and do all the things they’re interested in doing.”

Lytton did get home in time to celebrate her birthday with her family. The great-grandmother no longer gets tired and out of breath from the easiest of tasks. She also noticed improved strength following the procedure. A big difference compared to that January night a year ago.

“I couldn’t make it like I was,” she said. “I don’t think I would’ve lived.”

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