Written by Alan Moses
WEDNESDAY, May 24, 2023 (HealthDay News) — When a heart valve bursts with significant leakage, it can cause a major problem.
The good news: The condition, known as degenerative mitral regurgitation (DMR), can be treated with a minimally invasive intervention known as TEER (transcatheter edge-to-edge repair), a procedure that involves inserting a small clip to enable proper valve closure and blood flow.
The best news? A new real-world analysis is the first to definitively conclude that the vast majority of patients who have the procedure do well afterwards.
That should reassure the more than two million Americans who have been diagnosed with DMR.
“The treatment was successful in approximately 9 out of 10 patients for whom TER was used for mitral valve repair,” Dr. Raj Makar, senior author of the study, said in a statement.
These robust safety and efficacy results have been validated, despite advanced age and significant comorbidities [other health complications] of these patients,” added Makar, vice president of cardiovascular innovation and intervention at Cedars-Sinai Medical Center in Los Angeles.
Makar and his colleagues noted that the average age of more than 19,000 patients who were followed by the study team was about 82 years. All patients were diagnosed with severe DMR.
According to the American Heart Association (AHA), when a large valve leaks, what eventually happens is that every time the left heart chamber contracts, blood He should Then it only flows in one direction – from the heart’s ventricle through the aortic valve – it ends up flowing in two directions instead. As a result, the heart has to work harder than normal to pump the same amount of blood, which can lead to increased pressure both in the left heart chamber and in the veins that lead from the heart to the lungs.
Besides impairing lung function, if left untreated, severe mitral valve leakage can eventually cause the heart to enlarge to the point where heart failure develops.
Makar noted that the condition is more common than some might think, noting that “nearly 1 in 10 people over the age of 75 has a leaky valve.”
For many of these patients, open-heart surgery is the common intervention.
But, he cautioned, “there are a lot of older patients who are not the best candidates for open-heart surgery.”
Alternatively, many of these patients may improve with a less invasive procedure such as TEER, in which “the mitral valve is repaired by placing a clamp over the leaky portion of the mitral valve… Most patients go home in less than 24 hours, with a reduced risk of in-hospital deaths.”
Because the patients in the study ranged in age from 76 to 86, the researchers note that many had health complications beyond a leaky heart valve.
As a result, the study team divided the group of patients into three groups based on the patient’s eventual risk of not surviving the TEER procedure. About 10% were considered to have low surgical risk, approximately 70% were classified as intermediate risk, and just over 20% were identified as high risk.
Information on TEER results was obtained from a database maintained by the Association of Thoracic Surgeons and the American College of Cardiology.
A successful TEER score was defined as leading to a change in leak status from ‘severe’ to ‘better to moderate’, without any narrowing of the leaky valve. Post-operative mortality rates were also assessed at three points: while the patients were still in the hospital, one month and one year after the operation.
In the end, the researchers found that only 2.7% of TEER patients died within the 30-day period.
And across all patient risk categories, TEER reduced the severity of valve leakage among more than 95% of patients by the 30-day post-procedure mark.
“This procedure returns many patients to a more active life, a return to activities that some have not been able to do in years,” Makar said.
However, his team also noted that by the same 30-day mark, far fewer patients (67%) had ended up with what investigators described as “moderate or less” leakage.
This is concerning, said Dr. Gregg Fonarow, MD, director of the Ahmanson-UCLA Myocardial Center and co-director of the Preventive Cardiology Program at UCLA.
Noting that “there have been relatively few analyzes of this procedure in US clinical practice,” Fonarow acknowledged that Makar’s study indicates that for patients with moderate to severe valve leaks, the procedure “appears to be a reasonable treatment option.”
But at the same time, he suggested that “there are still other opportunities to improve this procedure,” given the low number of patients who had a “mild” post-TEER dropout.
Fonarow noted that a large randomized trial comparing the relative benefits of other surgery options to TEER verses is already under way.
The results were published May 23 in the Journal of the American Medical Association.
There’s more about leaky mitral valves at the American Heart Association.
SOURCES: Raj Makar, MD, associate director, Smidt Heart Institute, and vice president, Cardiovascular Innovation and Intervention, Cedars-Sinai Medical Center, Los Angeles; Greg Fonarow, MD, director of the Ahmanson-UCLA Cardiology Center, co-director of the Preventive Cardiology Program at UCLA, and co-chair of the Division of Cardiology, University of California, Los Angeles; Journal of the American Medical Association, May 23, 2023