MitraClip Repairs Leaking Valve When Surgery’s Not an Option
Last spring, Thomas McCabe’s long history of heart problems had left him almost confined to his Conshohocken home.
“I couldn’t walk very far,” says McCabe, 68. “With a set of eight or nine steps, when I’d get to the top I’d have to stop for a couple of minutes. I was afraid to drive. I couldn’t last long in a food store, maybe about 10 or 15 minutes. It was really getting annoying.”
But a procedure in April at Einstein Medical Center Philadelphia fixed the heart-valve problem that was causing his symptoms – without surgery. He was discharged the next day.
“I do believe that if it wasn’t for Einstein, I wouldn’t be here today,” he says.
MitraClip: a New Option
McCabe was one of the first patients at Einstein to receive a device called a MitraClip to correct a backflow of blood through the heart’s mitral valve, called mitral regurgitation. Usually the valve is repaired with open heart surgery, but the MitraClip can be used to help people who are too sick for surgery.
Einstein Philadelphia began offering the procedure in the spring of 2019. McCabe was “one of our first patients and he just did amazingly well,” says Christian Witzke, MD, an interventional cardiologist who performed the procedure along with cardiothoracic surgeon Alexandra Tuluca, MD.
“So it’s more encouraging to the next patient,” Dr. Witzke says. “The bottom line is that it’s an amazing technology.”
Dr. Witzke estimated that 30% of Einstein’s patients with mitral regurgitation are too sick for surgery. So far, 11 of them have received the MitraClip procedure. He’s expecting to double that by the end of the year.
“Most of our patients have been discharged the next day,” he says. “And they all come back into the office feeling so well, more energetic and less out of breath. So it’s a very successful procedure with low risk for complications, including minimal risk of excess bleeding. We’re very happy to have this treatment option.”
How Regurgitation Happens
The mitral valve regulates the flow of blood coming back into the heart from the lungs. The valve sits between the left atrium, one of the heart’s upper chambers, and the left ventricle below it. The valve’s two flaps open to allow blood to flow into the left ventricle, the main pumping chamber. Then the flaps close to prevent blood from flowing backwards.
Mitral regurgitation occurs when the flaps don’t close completely. As a result, some of the blood flows backwards into the left atrium. The condition can be caused by a variety of problems with the heart. Regurgitation can lead to shortness of breath, fatigue, an irregular heart rhythm and even heart failure.
The MitraClip looks like a little clothespin made of fabric-covered metal. The clip is attached to a long, thin tube called a catheter that the doctor inserts through a vein in the groin and then guides into place in the heart. It’s used to fasten the two flaps of the valve together in the middle, tightening the opening and reducing regurgitation.
Because there’s no need to open the chest or stop the heart, the MitraClip procedure reduces risk for a patient like McCabe, who has extensive heart conditions that place him at a high risk for valve surgery. McCabe believes most of his health problems were caused by alcohol. He quit drinking in 2003 after his first heart attack.
Earlier Valve Problem
McCabe first came to Einstein through the Emergency Department, where a doctor diagnosed a problem with his heart’s tricuspid valve. In 2016, he had a procedure at Einstein called ring annuloplasty. This surgery tightens the heart’s tricuspid valve by putting a plastic or metal ring around it.
The ring helped McCabe to breathe better and gave him more energy, but the recovery was tough, Dr. Witzke said. “He had a long hospitalization and a difficult post-surgical recovery.”
So when McCabe later developed mitral valve regurgitation, he didn’t want another heart surgery. The MitraClip seemed like the best option.
Dr. Witzke says he and Dr. Tuluca perform these procedures together because each of them has a different expertise. “I understand ultrasound and X-rays and catheters; that’s my niche. But she sees mitral valves anatomically more than I do because she’s in the OR and knows how the anatomy should be. So I think our skills blend together.”
Another important doctor on the team is Gregg Pressman, MD, a cardiologist who specializes in reading the ultrasound images provided by an echocardiogram to guide heart procedures.
McCabe still remembers waking up after the MitraClip procedure. “Dr. Tuluca was standing there. She got me up out of bed that afternoon, the second day. I wasn’t in the mood to do that. But she made me walk all the way down to one end of the hallway and all the way back. She wanted to know what I felt like. I felt pretty good.”
When he went home later that day, “I was afraid to do a lot because I wasn’t used to doing a lot. But then I started taking some short walks, and then the walks got longer.”
Now McCabe says he’s back to a more normal routine. “I feel 100% better.”
Learn more about Einstein Heart and Vascular Services.
MitraClip is a trademark of Abbott or its related companies. Photo reproduced with permission of Abbott, © 2019. All rights reserved.