Karolinska first with new method for valvular heart disease

News

Up to now there have not been any treatment options for patients who are too high-risk for open heart surgery with a cardiopulmonary bypass, and for whom transcatheter valve repair with a clip is not suitable. With a new method, Karolinska University Hospital has created Sweden’s first transcatheter procedure to replace the mitral valve.

With this new method, patients who were previously considered inoperable can be assessed and, if anatomically possible, offered the new transcatheter mitral valve implantation. The procedure was performed by cardiologist Magnus Settergren and cardiac surgeon Peter Svenarud with ultrasound guidance by cardiologist Kari Feldt and clinical physiologist Patrik Norgren (during end of 2019).

"There are patients with mitral regurgitation who can't even be subjected to minimally invasive heart surgery due to frailness and other illnesses that rule out a cardiopulmonary bypass. This new treatment method offers a brand-new opportunity to treat patients who were previously untreatable. We are at the dawn of a new era with transcatheter mitral valve replacement," says cardiologist Kari Feldt at Karolinska University Hospital.

In this method, the surgeons do not open the patient's ribcage as usual; rather, they make a small hole at the apex of the heart. A new mitral valve is inserted through a catheter, which is why it is called a transcatheter procedure. Guided by coronary ultrasound and radiology, the entire procedure is conducted on a beating heart, with no need of a coronary bypass.

Up to now, no treatment was available for mitral regurgitation in this patient group. They experienced progressive heart failure and premature death. The valve implant was conducted as a part of a phase IV study.

We can expect transcatheter mitral valve prostheses to become a part of regular healthcare within the next 1–2 years, starting with a few and gradually increasing.

Because many elderly patients are too high-risk for traditional surgery, and valvular heart disease increases with age, we can expect that this new method will help hundreds of people each year in Sweden alone.

"We at Karolinska University Hospital have developed the Nordic region's foremost center for treatment of valvular heart disease. This advanced form of care would not have been possible without highly specialized transcatheter treatment, minimally invasive heart surgery, advanced coronary diagnostics with ultrasound and CT scanning, and the close collaboration between cardiologists, cardiac surgeons, radiologists and anesthesiologists that we have at Karolinska," says cardiologist Magnus Settergren.

Facts

The mitral valve is between the left atrium and left ventricle in the heart. A damaged valve leaks, causing the oxygenated blood to be regurgitated back into the atrium and lungs when the heart tries to pump the blood out to the body. This leads to shortness of breath and lack of energy in the patient.

Mitral regurgitation, or mitral insufficiency, can be due to an acquired defect in the valve or because the surrounding ventricle has been enlarged due to heart failure, pulling the leaflets of the valve apart. The new transcatheter procedure can be applied in both cases.

The mitral valve is the second-most common heart valve operated on in Sweden. Currently about 800 patients a year undergo surgery for mitral valve prolapse, of which about 40% receive a prosthetic valve.