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By Alan Moses
HealthDay Reporter
WEDNESDAY, May 24, 2023 (HealthDay News) — When one of your heart’s valves leaks big, that can spell big trouble.
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 allow the valve to function properly. 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 undergo the procedure do well afterward.
That should reassure the more than 2 million Americans who have been diagnosed with DMR.
“Treatment was successful in nearly 9 out of 10 patients who had TEER used to repair their mitral valve,” study lead author Dr. Raj Makkar said in a statement.
“These robust safety and efficacy results were validated, despite advanced age and significant comorbidities. [other health complications] of these patients,” added Makkar, vice president of cardiovascular innovation and intervention at Cedars-Sinai Medical Center in Los Angeles.
Makkar and his colleagues noted that the average age of the more than 19,000 patients followed by the study team was about 82 years. All patients had been diagnosed with severe DMR.
According to the American Heart Association (AHA), when a major valve leak occurs, what ends up happening is that every time the left chamber of the heart contracts, the blood that ought then flow in only one direction, from the ventricle of the heart through the aortic valve, ends up flowing in two directions. As a result, the heart has to work harder than normal to pump the same amount of blood, which can increase pressure both in the left chamber of the heart and in the veins leading from the heart to the lungs.
Beyond impairing lung function, if left untreated, a severe mitral leak can ultimately cause the heart to enlarge to such an extent that heart failure develops.
The condition is more common than some might think, noted Makkar, noting that “nearly 1 in 10 people over the age of 75 have a leaky valve.”
For many of these patients, open-heart surgery is the common procedure.
But “there are many older patients who are not the best candidates for open-heart surgery,” he cautioned.
Instead, many of these patients may fare better with a less invasive procedure such as TEER, in which “the mitral valve is repaired by placing a clip on the leaking part of the mitral valve…Most patients they go home in less than 24 hours, with a low risk of in-hospital mortality.”
Because the study patients were between the ages of 76 and 86, the researchers noted that many struggled with health complications beyond a leaky heart valve.
As a result, the study team divided the group of patients into three groups based on the risk that the patient would ultimately not survive the TEER procedure. About 10% were considered to face low surgical risk, almost 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 Society of Thoracic Surgeons and the American College of Cardiology.
A successful TEER result was defined as the result of a change in leak status from “severe” to “better to moderate”, without any narrowing of the leaking valve. Post-procedure mortality rates were also assessed at three points: while the patients were still hospitalized, and both one month and one year after the procedure.
In the end, the researchers 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 leakage in more than 95% of patients at 30 days post-procedure.
“The procedure is returning many patients to more energetic lives and activities that some have not been able to do for years,” Makkar said.
Still, his team also noted that at the same 30-day mark, far fewer patients (67%) ended up with what the researchers characterized as a fugue state that amounted to “mild or less.”
That’s concerning, said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of the UCLA Preventive Cardiology Program in Los Angeles.
Noting that “there have been relatively few analyzes of this procedure in US clinical practice,” Fonarow acknowledged that Makkar’s study suggests that for patients with moderate to severe valve leaks, the procedure “appears to be an option of reasonable treatment”.
But at the same time, he suggested that “there remain more opportunities to improve this procedure,” given fewer patients achieving a “mild” fugue state after TEER.
Fonarow noted that a large randomized trial is already underway comparing the relative benefits of other surgical options versus TEER.
The findings were published May 23 in the Journal of the American Medical Association.
More information
There is more information on leaky mitral valves from the American Heart Association.
SOURCES: Raj Makkar, MD, associate director, Smidt Heart Institute, and vice president, cardiovascular innovation and intervention, Cedars-Sinai Medical Center, Los Angeles; Gregg Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of the UCLA Preventive Cardiology Program, and co-director of the division of cardiology at the University of California, Los Angeles; Journal of the American Medical Association, May 23, 2023
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