A study shows promising results of a new mitral valve procedure in high-risk patients

An innovative method for mitral valves shows promise for high-risk patients in a new study by the University of Miami Miller School of Medicine led by Joseph Lamelas, MD, head and program director of cardiothoracic surgery.

Limited surgical treatments are available for high-risk patients with hardened annular mitral calcification, hardening of the ring at the base of the valves. Our team has achieved good results with a transcatheter aortic valve prosthesis that is less aggressive in mitral valve position (MVR-TAVR). “

Dr. Joseph Lamelas, MD, Head and Program Director of Cardiothoracic Surgery

Dr. Lamelas was the lead author of the study, “Early Outcomes for MAPral Surgery Valve Replacement Surgery SAPIEN 3,” published in Biography of thoracic surgery, journal of the American Thoracic Society. His co-author Ahmed Alnajar, MD, was an analyst in Dr. Lamelas ’laboratory. The findings of the study were presented at the 2020 meeting of the Association of Thoracic Surgeons.

Annular mitral calcification is a malignant, degenerative calcification of the fibrous material around the mitral valve, which sits on a circular or oval ring in the heart. “This is a high-risk disease that occurs in up to 15 percent of high-risk patients, contributing to high rates of adverse outcomes and mortality,” Dr. Lamelas said.

To treat this condition, Dr. Lamelas takes a SAPIEN 3 aortic valve that can be expanded by Edwards Lifesciences, turns it around and delivers it into the patient’s mitral valve. “It needs to be positioned carefully to avoid blood leakage through small gaps around the annular ring,” he said. “Also, if the new valve is placed too deep, it can block the flow of blood. leaving the heart, so careful imaging is required throughout the process. “

The Miller School study targeted 16 patients aged 53 to 88 who underwent MVR-TAVR procedures between 2017 and 2019. They all had poor abilities, including previous heart surgery, right ventricular dysfunction, severe hip-pulmonary hypertension, and renal failure. The 30-day mortality rate was estimated at 12.5 per cent – much lower than the 30 per cent recorded in a recent record for transcatheter MVR and 20 per cent for the transgender surgery procedure. reported in the same study.

“Our experience is associated with a high rate of technical success, a low complication rate, and an appropriate 30-day mortality rate in patients with large and extensive mitral annular complication,” he said. “It is a viable alternative to conventional mitral valve replacement, although it requires an important learning curve due to the variable anatomy and comorbidities of individual patients.”

Looking ahead, Dr. Lamelas said the treatment of these high-risk patients requires improved surgical techniques, additional valve design, careful patient selection, detailed imaging, and extensive surgical experience. He said, “Our goal is to get safe and satisfactory results for patients with these real heart problems.”