By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    How Not to Become a Victim of Medical Scams
    How Not to Become a Victim of Medical Scams
    December 22, 2021
    11 Ways You Can Care for Your Elder Family Members Health
    11 Ways You Can Care for Your Elder Family Members Health
    April 6, 2022
    How Can Brain Injury Lead To Dangerous Long-Term Effects?
    How Can Brain Injury Lead To Dangerous Long-Term Effects?
    August 30, 2022
    Latest News
    6 Easy Healthcare Ways to Sit Less and Move More Every Day
    September 10, 2025
    7 Most Common Healthcare Accreditation Programs: Which Should You Use?
    August 20, 2025
    Hospital Pest Control and the Fight Against Superbugs
    August 20, 2025
    Hygiene Beyond The Clinic: Attention To Overlooked Non-Clinical Spaces
    August 13, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Why are Girls Being Abandoned and Battered ?
    August 20, 2012
    biopharma beat innovation and imagination
    BioPharma Beat: Imagination Is More Important Than Innovation
    August 5, 2014
    HIPAA Compliance Breaches Higher Than Ever: What Are You Doing About It?
    April 26, 2016
    Latest News
    Healthcare at a Crossroads: Why Leadership Matters More Than Ever
    September 9, 2025
    How Social Security Disability Shapes Access to Care and Everyday Health
    August 22, 2025
    How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
    August 22, 2025
    How One Fall Can Lead to a Long Road of Medical Complications
    August 22, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Repairing Heart Valves Without Open Surgery – A Significant Advance
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Specialties > Cardiology > Repairing Heart Valves Without Open Surgery – A Significant Advance
BusinessCardiologyMedical DevicesTechnology

Repairing Heart Valves Without Open Surgery – A Significant Advance

StephenSchimpff
StephenSchimpff
Share
9 Min Read
SHARE

Continuing last week’s discussion of new devices for treating heart diseases, a major innovation are the recent reports of success in replacing or repairing diseased or damaged  aortic or mitral valves via catheter-based techniques instead of open surgery.                        

Continuing last week’s discussion of new devices for treating heart diseases, a major innovation are the recent reports of success in replacing or repairing diseased or damaged  aortic or mitral valves via catheter-based techniques instead of open surgery.                        

 Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, replace the valve or do a procedure that in effect lessens the amount of regurgitation without actually replacing the valve. The latter procedure, although not curative, can be quite successful and alleviate the heart failure and the symptoms thereby leading to a longer and better quality life.

 A new procedure that does not use open surgery to repair the mitral valve leak was recently reported in the New England Journal of Medicine. The process is to pass a catheter via the groin to the heart and position it at the opening of the mitral valve. This mechanical device, manufactured by Abbott Vascular, is able to grasp the two sides of the mitral valve and clip the two leaflets together. It does not create a tight seal but in most cases can markedly reduce the amount of regurgitant flow back into the atrium.

More Read

The Incredible Shrinking Small Business Health Insurance Tax Credit
How Predictive Modeling Can Save Healthcare
F.D.A. Approves Stem Cell Therapy to Reduce Facial Wrinkles
10 Questions To Ask Before Hiring An Orthopedic Surgeon
Health Start-Ups! – ACA Will Help Self-Employed and Would-be Entrepreneurs

 279 patients with grade 3+ or 4+ (i.e., serious) mitral valve dysfunction were randomized 2:1 to have a percutaneous repair done with the new device or the customary open repair or replacement (the specific procedure at the surgeon’s discretion based on the valve status). 21 patients withdrew consent before the procedure was done, leaving 258 treated patients.

 By the 12 month end of study time, the composite of freedom from death, from surgery or from grade 3+ or 4+ valve dysfunction for all randomized patients were 55% (catheter-based) vs. 73% (open surgery). Of those treated per the protocol (i.e., did not exclude themselves, etc) then the rates were 72% vs. 88%. The rates of major adverse events (most often the need for transfusion) as of 30 days were 15% vs. 48%. Quality of life improved in both groups of patients over the 12 months although there was a decrease at 30 days for the open surgery patients.

 What these results suggest is that open surgery is more likely to greatly relieve the mitral regurgitation than will the percutaneous catheter procedure. However, the percutaneous procedure is safer, requires less time in the hospital, and is associated with improved quality of life and improved ventricular function from baseline. Many patients might therefore decide to choose the percutaneous catheter-based procedure on the grounds that it greatly relieves the problem in almost three quarters of the patients, is less invasive and is safer than surgery. Then if that individual patient was not among the success stories, he or she can choose to have the follow-up open surgery.

 Further, although not mentioned in this article, there are patients who simply cannot tolerate open surgery for any number of reasons who might still be able to undergo the catheter-based procedure. This might then create an option for repair not otherwise available today with open surgery. Not discussed in the article was cost. This might become a deciding factor as well. 

 Aortic stenosis is not uncommon in older individuals and they are rapidly increasing in numbers. Once the first symptoms develop, about 50% of patients with aortic stenosis will die within 2 years. Surgical replacement of the aortic valve will improve both heart function and survival. Unfortunately, about 30% of symptomatic individuals cannot undergo surgery because of older age, other heart problems or other medical conditions that render surgery too risky.

 The new approach is called transcatheter aortic value implantation (TAVI.) In this procedure, a catheter is inserted into the femoral artery in the groin and run up to the heart. From the catheter, the patient’s valve is opened wide with an inflatable balloon. Then a bioprosthetic valve (Edwards Lifesciences)  made from bovine pericardium affixed to a stainless steel support frame is deployed into place via another balloon catheter and secured to the patient’s own aortic valve base.

 A randomized study of 358 patients with aortic stenosis not considered surgical candidates comparing TAVI to standard therapy was reported in the New England Journal of Medicine on October 21, 2010. The results were clearly favorable. Standard medical therapy was noted to not alter the natural history of aortic stenosis with 51% dead in one year. TAVI was superior with improved cardiac symptoms and good hemodynamic performance of the new valve which persisted for at least the first year of follow-up and with 31% dying during that year, a substantial decline in mortality.

 But – and it is a significant “but” – TAVI was associated with a 5% risk of serious stroke (compared to 1% in the control group.) Further, MRI studies of patients suggest that many had new perfusion defects of the brain after TAVI suggesting that emboli from the new valve may be rather common.

 But all things considered the improvement in symptoms and the reduced deaths argue that TAVI is now the appropriate therapeutic approach for those with aortic stenosis who cannot otherwise undergo surgery. Hopefully, coming improvements in the device will lead to fewer complications.

 About six months later, the same investigators reported on 699 high risk but nevertheless surgical candidate patients who where randomized to either TAVI or open valve replacement. At one year about 25% of patients in both groups had died suggesting that the TAVI approach was not inferior to open replacement. The rates of major stroke at one year were 5.1% (TAVI) and 2.4% (open surgery). Adverse events were about twice as common in the surgical patients as was new onset atrial fibrillation (8.6% vs. 18%).

 These two new approaches to valve repair or replacement without open surgery creates a new venue for cardiac care – one that will undoubtedly develop and improve in the years to come. It is a testament to innovators skills and determination.

Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and consults for the US Army, medical startups and Fortune 500 companies. He is the author of The Future of Medicine – Megatrends in Healthcare and his new book, the Future of Health Care Delivery, out Feb, 2012. Updates are available at http://medicalmegatrends.blogspot.com

 

 

 

 

 

 

 

TAGGED:aortic valvesheart diseasemitral valves
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

a woman walking on the hallway
6 Easy Healthcare Ways to Sit Less and Move More Every Day
Health
September 9, 2025
Clinical Expertise
Healthcare at a Crossroads: Why Leadership Matters More Than Ever
Global Healthcare
September 9, 2025
travel nurse in north carolina
Balancing Speed and Scope: Choosing the Nursing Degree That Fits Your Goals
Nursing
September 1, 2025
intimacy
How to Keep Intimacy Comfortable as You Age
Relationship and Lifestyle Senior Care
September 1, 2025

You Might also Like

Is Europe A Better Place To Build A Medical Technology Company?

March 31, 2011

The Future of Health Insurance

April 21, 2013
BusinessFinancePolicy & Law

Looming PR Challenge: When Physicians’ Pay Links to Quality of Care

January 25, 2013
eHealth and innovation
BusinessFinanceHealth ReformHospital AdministrationPolicy & LawPublic HealthTechnology

Why Patients Need “E Interventions” Now

October 9, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?