Transcatheter Treatment of Mitral Regurgitation

Despite improvements in bioprosthetic valve function, increased human life–expectancy has led to a growing number of bioprosthetic valve deterioration cases requiring reoperation. The authors report 2 cases of primary tissue failure of a bioprosthetic valve, which were treated by mitral valve replacement using the valve–on–valve method. The reasons for the reoperations were a severely calcified valve annulus, and severe adhesion of a previous bioprosthetic valve. The authors removed only the leaflets of the bioprosthetic valve and sutured a Carbomedics OptiForm valve onto the sewing cuff of the previous bioprosthesis. No complications, including major cardiac events, were noted during the follow–up.

Degenerative mitral regurgitation due to leaflet prolapse is common and can be surgically repaired in the vast majority of patients, thus improving symptoms and restoring normal life expectancy. Despite the safety and efficacy of contemporary mitral valve repair, an ongoing international debate persists regarding the need for early intervention in patients without class I indications (that is, individuals with no or minimal symptoms and normal left ventricular function).

There are four heart valves. The mitral valve is between the heart's left atrium (upper, holding chamber) and left ventricle (lower, pumping chamber). The mitral valve has two flaps, or cusps.

Mitral valve repair is by far the best option for most patients with mitral valve disease. This is because, compared to mitral valve replacement, it has significant advantages, including: improved life expectancy, avoidance of long term of anticoagulation, and better preservation of native heart function.

Did you know that the most common type of heart valve disorder is mitral regurgitation, sometimes called a “leaky valve”? This happens when the valve between the upper and lower chambers on the left side of the heart do not close properly, which can cause a decrease in blood flow to the rest of the body.

Edwards Lifesciences Corporation (NYSE: EW) has announced that it has received CE Mark in Europe for valve-in-valve procedures using the SAPIEN XT transcatheter heart valve, providing a minimally invasive treatment option for patients whose surgical mitral or aortic valves require replacement, and who are at extreme risk for surgery.

Prosthetic heart valves, due to the continuous stress they're subjected to, have a limited lifetime and may even require replacement once worn out.

Edwards Lifesciences just received European CE Mark approval to offer the SAPIEN XT transcatheter valve for valve-in-valve procedures. The SAPIEN XT is indicated for implantation inside both mitral and aortic valves, and can reside on top of a previously installed prosthetic valve.

Most rheumatic mitral valves have undergone replacement in recent years, but replacement mortality remains significant at a time when repair mortality is approaching zero. Therefore, an effort was made to increase repair rates and efficacy in a single surgeon series of patients having operation for rheumatic mitral valve disease.

“I went from being 25 percent operational to 100 percent,” said Hothan. MVR can seem a miraculous procedure to patients who, like Hothan, have been struggling for years.

Thoracic Surgery News, the official newspaper of the American Association for Thoracic Surgery - now published 10 times per year! This publication will include sections devoted to the news of general thoracic surgery, adult cardiac surgery, transplantation, and congenital heart disease. Content for Thoracic Surgery News is provided primarily by the Elsevier Society News Group/Elsevier Global Medical News and by the American Association of Thoracic Surgery.