Dr. Iyengar on 'Revolutionary' Heart Valve Repair and Replacement

People with mild heart valve problems often live long, full lives and never require treatment. But once a diseased valve begins to affect your heart’s ability to pump blood, you may need a valve repair or replacement to prevent serious complications such as congestive heart failure, atrial fibrillation, pulmonary hypertension or even death.

“Fortunately, in the last decade there’s been a revolution — not just an evolution — in repairing or replacing heart valves,” said BCH structural heart program director Dr. Srini Iyengar during a free health lecture.

“We now have the capability to address serious internal cardiac issues with minimally invasive techniques. The results with certain procedures have shown to be equivalent to, if not better than, traditional surgical treatment,” he said.

Heart Valve Disease: A Problem of Faulty Heart Valves
The heart has four heart valves that control blood flow into and through the heart. They are the aortic, mitral, pulmonic and tricuspid valves.

“Heart valve disease occurs when a valve becomes damaged, leading to a backflow of blood or complete blockage of blood flow. Although problems with heart valves are often linked to age-related factors, sometimes they can develop from illnesses such as rheumatic fever or infective endocarditis,” Dr. Iyengar said.

Two main problems can occur with these valves: regurgitation and stenosis. Regurgitation occurs when a valve does not fully close and allows blood to leak backwards. This is commonly referred to as a leaky valve. Stenosis is the narrowing of a valve that prevents blood flow. It is often described as a tightening valve.

Any of the four valves can have regurgitation or stenosis—sometimes both—but the mitral and aortic valves are most likely to be damaged.

Minimally Invasive Endovascular Valve Repair or Replacement
Treatment for mitral or aortic valve disease depends on the severity of the damage and may include prescribed medication. However, medications can only help manage the symptoms and cannot reverse the underlying problem.

If your condition becomes severe, you may need a valve repair or replacement. Usually this requires open-heart surgery, the gold standard treatment, according to Dr. Iyengar. During this procedure, patients are connected to a heart-lung bypass machine, which does the work of the heart while their heart is stopped.

Yet open-heart surgery becomes riskier with those too frail to endure such an invasive procedure.

“For these high-risk patients a minimally invasive endovascular procedure can be a safer alternative. These new procedures don’t require opening up your chest or being placed on a heart-lung machine,” said Dr. Iyengar. “They can also result in reduced scarring, less postoperative pain and a shorter recovery time, when compared to open heart surgery.”

Endovascular valve repair or replacement procedures involve inserting a catheter through a small incision in the upper leg and guiding it through your vein—via fluoroscopy (special x-ray) and echocardiography (type of ultrasound)—to reach the heart.

Your doctor will determine whether:

• Mitral valve repair or replacement is the most appropriate for your condition.
• You're a candidate for either open-heart surgery or a minimally invasive endovascular procedure such as MitraClip® Therapy or TAVR.

MitraClip for Mitral Valve Repair
Dr. Iyengar explained how Boulder Community Health’s full-service cardiology program—the only one in Boulder County—recently added MitraClip® Therapy to its range of minimally invasive endovascular treatments.

The procedure repairs a leaky mitral valve by using a small, dime-sized clip to close the center of the valve. The physician guides the clip through a large vein in your leg to your heart via a steerable catheter, which delivers and attaches the device to the mitral valve. Once the clip is attached, your mitral valve closes more completely, helping to restore normal blood flow through your heart.

“Clinical data from patients who underwent the MitraClip procedure demonstrate an immediate reduction of mitral regurgitation and a low hospital length of stay of just 2.9 days,” Dr. Iyengar said.

He added, “Patients who were studied one year after the procedure continued to experience improvement in their quality of life. And, there was a 73 percent reduction in hospitalizations for heart failure in the year following the procedure compared to the year prior.”

MitraClip Therapy is FDA approved only for people with mitral regurgitation for whom surgery is too risky.

TAVR: Newer, Less Invasive Treatment for Aortic Stenosis
Many people who have aortic stenosis live without symptoms for many years. Yet once they start to experience even minor symptoms, urgent treatment is critical. The disease progresses rapidly, and when it becomes severe the prognosis is poor.

“For those with severe aortic stenosis, the survival rate is low when left untreated. Half of those who develop aortic valve stenosis die within two years after the onset of symptoms and 20 percent at five years without treatment,” Dr. Iyengar told the audience. “However, studies show getting an artificial heart valve lowers that death rate to as low as 17 percent.”

An alternative to traditional open-heart valve replacement surgery is a new, less invasive endovascular option called Transcatheter Aortic Valve Replacement (TAVR). The procedure involves replacing the faulty valve by threading a synthetic one through a blood vessel.

The U.S. Food and Drug Administration (FDA) recently expanded the number of patients diagnosed with severe aortic stenosis who will be able to receive TAVR. It opened use of TAVR to low-risk patients.

To make an appointment with Dr. Srini Iyengar, or if you have further questions about heart valve disease, contact Boulder Heart’s Structural Heart Team at 303-442-2395.

View PowerPoint slides from Dr. Iyengar’s lecture on “Latest Heart Valve Treatments.”

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