High-tech heart-valve fix brings hope for high-risk patients

Leading-edge therapy heals patients who are too weak for open-heart surgery

EDMONTON — People living with shortness of breath, fatigue and heart failure due to a leaky mitral valve — but who are too frail or high risk for open-heart surgery — now have a new option to regain their health and vitality.

“These people can’t even walk a block without being short of breath. With our new valve-clip procedure, we can improve upon that,” says Dr. Kevin Bainey, an interventional cardiologist at the Mazankowski Alberta Heart Institute. “Before this procedure, there were no other options for patients who could not have open-heart surgery.”

Their condition, known as mitral regurgitation (MR), is one of the more common types of heart valve disease, affecting nearly 1 in 10 people aged 75 years and older. It occurs when the flaps of the heart’s mitral valve — situated between the main pumping chamber, the left ventricle, and the left atrium, which receives all the blood from the lungs — fail to close completely, causing blood to flow backward into the left atrium and into the lungs.

To compensate and keep up blood flow through the body, the left ventricle pumps harder, straining the heart. Symptoms of MR include: shortness of breath, fatigue, coughing, lightheadedness and swollen feet or ankles. MR also raises the risk of irregular heartbeats, stroke and congestive heart failure, which can be life-threatening.

“Instead of having to open the chest, we can now repair the valve in a minimally-invasive way, using catheters inserted in the groin to guide the valve clip in place on the failing valve,” says Dr. Bainey. “This device grasps the valve flaps to close the centre of the valve, leading to relief of symptoms. Patients usually go home the next day, feeling much better. Recovery is great!”

“Historically, these patients have been treated with surgery,” adds Dr. Ben Tyrrell, an interventional cardiologist with the CK Hui Heart Centre at the Royal Alexandra Hospital. “But often their heart muscle is just so weak that they’re not able to tolerate open-heart surgery, which also means they’re not candidates for a heart transplant or a mechanical heart, either.”

Teamwork between the Maz and the CK Hui helped to bring the new procedure to Edmonton.

As well, such advanced surgery would not be possible without the University Hospital Foundation, whose donors provided $6.6 million to fully fund the development of the Mazankowski’s hybrid operating room, where these procedures take place. Since 2014 it has allowed interventional cardiologists (cardiac specialists who treat heart defects using minimally-invasive, catheter-based techniques) and a cardiac surgeon to work simultaneously in an operating theatre, which also features the advanced echocardiography imaging system needed for catheter procedures.

“The Foundation funds state of the art technology and supports research and education that is essential to advancing the care that we provide at the Maz,” says Mishaela Houle, Executive Director of Cardiac Sciences for AHS in Edmonton Zone. “It’s this support that helps us realize our vision of being Leaders in Patient Care.”

To date, the pilot program has seen six patients undergo the procedure, which isn’t for everyone.

“It’s still a niche procedure right now,” says Dr. Tyrrell. “There are lots of anatomical considerations in picking the right patients for this catheter approach. There are tried-and-true surgeries that are still great therapy for a lot of patients.”

While surgical MR patients can expect to spend five to seven days in hospital, followed by three to six months of healing at home, valve-clip patients fully recover and go home within a day.

“I had good success with that. I’m doing much better,” says Bruce Davis, 80, a retired RCMP officer who had his valve repaired in March. “For years before, my quality of life wasn’t good. I tired easily. I puffed on the stairs. I wasn’t interested in anything. Life had become a drag.”

His wife Kathy, a retired RN, adds: “Gradually he became weaker and weaker, and less likely to get out of his chair. But right after his surgery, when he woke up, he had colour in his cheeks for the first time in years. He felt so much better it was amazing. He now likes to get up and do things around the house. It’s been an enormous change.”

Meanwhile, on the research front, Edmonton will soon help to pioneer the replacement, via catheter, of the entire mitral valve with a newly-developed synthetic valve. The procedure is likely to be performed in the near future once a suitable patient has been identified.

“We’re part of an early feasibility study that was recently approved by Health Canada,” says Maz cardiac surgeon Dr. Steve Meyer. “We’re one of only three sites in North America doing this.”

Maz cardiologist Dr. Robert Welsh, Edmonton Zone Clinical Department Head for Cardiac Sciences, says: “Minimally invasive approaches to valve therapy are revolutionary therapy. These technological advances are allowing us to improve quality of life for this important and growing patient population.”

Images and illustrations of the mitral clip are available upon request.

The University Hospital Foundation advances the health of Albertans by connecting generosity to support innovation and excellence at the University of Alberta Hospital, the Mazankowski Alberta Heart Institute and the Kaye Edmonton Clinic.

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

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