Doctors Medical Center of Modesto now has a minimally invasive procedure for fixing mitral valves for older or sicker patients who are a high risk for surgery.
Dr. Talwinderdeep Kahlon was trained on the East Coast in transcatheter mitral valve repair and performed the first TMVR at the Modesto hospital in October.
The procedure is the latest addition to the hospital’s cardiac program.
Many patients with minor mitral-valve leakage are scheduled for periodic checkups with a cardiologist, but they can keep playing golf or enjoy travel. Those patients won’t require treatment unless symptoms emerge.
If the problem worsens for relatively healthy adults, valve replacement and repair surgeries are widely available. In the past, older patients who were too weak for surgery had to travel to Sacramento or the Bay Area for a minimally invasive procedure. Many of the those patients just lived with the life-changing symptoms.
A person with severe leakage, causing blood to flow backward into the heart, often has shortness of breath, fatigue, swollen ankles and a diminished quality of life, because an ample supply of blood is not circulating through the body. Going without treatment leads to the worst effects of heart failure and death.
The possible causes of mitral valve regurgitation include heart defects, damaged tissue, rheumatic fever or infection of the heart’s lining.
Some who undergo the TMVR procedure have multiple health conditions.
“Most of these patients were not being treated,” Kahlon said in an interview this month. “Most of them are advanced in age, 70 years or older, who won’t do well with open-heart surgery. It is tough for them and their families to travel to the Bay Area (for TMVR.)”
Karen Dunlava, 70, of Copperopolis, had congestive heart failure causing fluid to build up around her heart. Climbing the nine steps to the front door of her home was a struggle and she would stop halfway to catch her breath.
Doctors said she wasn’t well enough for valve-replacement surgery that could require cutting an opening in the chest. “They said I just had to put up with congestive heart failure,” Dunlava recalled.
In October, Dunlava became seriously ill and was airlifted to Doctors Medical Center in Modesto. At Doctors, cardiologists suggested a transcatheter mitral valve repair might resolve her problems and make her feel better. No one had ever mentioned the option to her before, she said.
Dunlava said the procedure performed at Doctors, taking about three hours, has improved her heart function.
According to Kahlon, the minimally invasive repair is one of the most complex treatments using transcatheter techniques.
A wire and catheter are run through a small incision in the leg and moved through the body to the left chamber of the heart. Guided by ultrasound images, Kahlon said, he makes a small hole in the heart at the right position and goes across the heart to the mitral valve, which has flaps that open and close, allowing blood to flow to the left ventricle.
Kahlon uses a metal MitraClip to grab the flaps, so the valve closes completely and blood doesn’t flow back into the heart. The clip is left in place while the catheter and wire are removed from the body.
Kahlon said repairing the leak may require two clips. It’s one reason a larger clip is being developed for TMVR procedures.
With the minimally invasive approach, patients are in the hospital for one or two days, and their symptoms may improve almost immediately, the hospital said.
Since the MitraClip received FDA approval in 2013, there is not much data on long-term outcomes. The possible complications cited in research literature include major bleeding, stroke and heart attack, though complication rates were low.
In July, the FDA approved a more advanced MitraClip system that’s easier to navigate through the patient’s body.
Dunlava said this week she has more stamina thanks to the procedure done this fall. She can make her bed without sitting to catch her breath and can climb those steps to the front door of her home.
Dunlava, who takes medication for a kidney transplant in 2009, was pleased she wasn’t put on more drugs after the mitral valve repair.
“Hopefully, this will keep me from going to the hospital every year,” Dunlava said.