Treating Structural Heart Disease: TAVR, MitraClip
CHI Health offers cutting-edge treatment for structural heart disease patients, which includes the minimally invasive procedures known as transcatheter aortic valve replacement (TAVR) and MitraClip.
The TAVR procedure is for patients who suffer from aortic stenosis, a progressive disease that affects the aortic valve of the heart and often causes restrictions in routine activities. Initially, it was approved for patients who weren’t considered good candidates for traditional open-heart surgery due to poor health.
Since there is no medical treatment for aortic stenosis, studies show that 50 percent of patients who don’t receive a valve replacement are unlikely to survive more than an average of two years after symptoms begin. The TAVR procedure repairs the heart valve without removing the damaged valve by placing a replacement valve into the aortic valve’s place, using a catheter with an expandable balloon. This is achieved by entering at the groin area and going through an artery.
“It is a revolutionary procedure that has been performed for the last 10 years outside of America in Europe and elsewhere,” said Himanshu Agarwal, MD, an interventional cardiologist for CHI Health. “It is so effective and was so revolutionary because you can repair a patient’s valves without the need for open-heart surgery.
“If someone had a bad valve, it used to be that the only treatment was to cut their chest open, take the bad valve out and put a new one in,” he said. “With the TAVR procedure, you can go from the groin and then put in a valve, which is mounted on a balloon, and then we blow that balloon up and the new valve will take over.”
While surgery is still the most common method of replacing valves, Dr. Agarwal said, TAVR is certainly the best option for high-risk patients.
“When you compare open-heart surgery — with a recovery time of six weeks and all the possible complications with surgery — to the TAVR procedure, which basically doesn’t require surgery, TAVR is a great option,” Dr. Agarwal said. “The new valves perform very well and typically last for 10 to 15 years.”
At the Nebraska Heart Institute (NHI) in Lincoln, Steven Martin, MD, and his team have participated in three studies regarding the TAVR procedure, dating back to 2011 — prior to FDA approval. After taking part in studies on how TAVR impacts high- and moderate-risk patients, Dr. Martin said, NHI is among 50 U.S. facilities starting to enroll low-risk patients to see how well they might react to TAVR.
“That will be really interesting to find out. Conventional valve replacement has been the standard because it has just been done for decades, so it’s time-tested and we know that it’s good treatment,” said Dr. Martin, an interventional cardiologist at NHI. “But now that we have seen the trial results for intermediate-risk patients and we know it’s good for high-risk patients, it begs the next question: What about your fairly healthy guy whose only issue is an aortic valve? That’s what we’re excited to be a part of and we were very happy to be chosen.”
Another less-invasive treatment option offered by NHI and CHI Health for heart-failure patients is MitraClip. While the TAVR procedure is typically performed to open up a narrow valve, the MitraClip procedure closes down a leaky mitral valve.
“That valve is a little more complicated to work on,” Dr. Martin said. “With the MitraClip procedure, the valve kind of swings open like a swinging door and it stops at a frame. But when there’s a problem with the door, so to speak, they can put a clip in the middle of the door that is almost like a staple to sort of keep it closer together so it leaks a lot less.
“Is it a perfect result? No. But it makes it a lot less leaky so that patients are hospitalized a lot less and they seem to be functioning much better. You can surgically fix this group of patients, too, but a lot of them are pretty high-risk for surgery,” he said.
The recovery time required after both TAVR and MitraClip procedures is fairly minimal. Patients can often return home within a couple of days.