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Less is More: Minimalist Mitral Valve Repair: Expert Opinion of Prem S. Shekar, MD, Chief, Division of Cardiac Surgery, BWH – #7, 2017 Disruptive Dozen at #WMIF17

Reporter: Aviva Lev-Ari, PhD, RN

Highlights LIVE Day 3: World Medical Innovation Forum – CARDIOVASCULAR • MAY 1-3, 2017  BOSTON, MA • UNITED STATES

SOURCE

https://pharmaceuticalintelligence.com/2017/05/03/highlights-live-day-3-world-medical-innovation-forum-cardiovascular-%E2%80%A2-may-1-3-2017-boston-ma-%E2%80%A2-united-states/

Excerpts from Prem S. Shekar, MD Presentation

The success achieved with TAVR

1. least traumatic
2. short recovery
3. quicker return to normal lifestyle

encouraged Medical devices Manufacturers to develop Mitral Valve Repair technologies to address the large unmet need for percutaneous treatment of patients with Mitral Valve disease:

Mild or Severe (4 Million in the US, alone).

• Mitral Regurgitation (MR) – imperfect closure of the valve permits blood from LV to return back towards the lungs.

Causes for MR

1. the degenerative myxomatous disease
2. senile calcific degenerative disease causing enlargement of the LV, infection or Trauma.

• Mitral stenosis – narrowing of the valve

Causes for Mitral Stenosis

1. rheumatic fever
2. senile calcific degeneration – obstruction to the forward flow of blood resulting in increased fluid pressure inside the lungs.

Symptoms of MR – managed by drugs or Surgery for correction (Open Heart surgery or MIS – both procedures require use of bypass machine, the heart been stopped for the duration of repair/replacement) for Valve Repair or Valve Replacement

1. shortness of breath
2. fatigue

Uncorrected Mitral Valve disease can lead to 

1. irregular heart rhythms
2. increased risk for stroke
3. CHF
4. Death

Transcatheter Mitral Valve Correction

1. Valve replacement
2. use of Repair devices on the Mitral leaflets
3. implantation of neochords
4. remodeling of the mitral annulus

Comparison of TARV with Transcatheter Mitral Valve Correction

1. Aortic Valve vs Mitral Valve: difference in complexity and artistic nature of Mitral repair
2. Ability to perform a Percutaneous repair on a Mitral Valve with same degree of accuracy and reproducibility as a Percutaneous repair on an Aortic Valve — will remain a challenge.
3. development of advance imaging technologies will play a key role in achieveing success with Percutaneous repair on a Mitral Valve
4. Percutaneous repair on a Mitral Valve need to overcome the complex structure and integrated relationship with the LV.

Leading Challenges in the Development of Percutaneous repair on a Mitral Valve Technologies

1. Mitral is a bigger Valve than the Aortic
2. It is more difficult to access
3. It is Asymmetrical
4. It lacks an anatomically well-defined annulus to which to anchor the artificial valve
5. Its geometry changes throughout the cardiac cycle
6. Placement of a replacement valve bears the risk of LV outflow tract obstruction

Patient Candidate Profile forPercutaneous repair on a Mitral Valve

1. Patient with a failed Mitral Valve bioprosthesis – Severe Mitral Valve Disease
2. Failed Mitral Valve Repairs
3. Senile calcific degeneration
4. Mitral Regurgitation unmanaged by medication
5. Variable surgical risk related to co-morbidities

Other related articles on Mirtal Valve Disease covered in this Open Access Online Scientific Journal Include the following:

Mitral Valve Repair: Who is a Patient Candidate for a Non-Ablative Fully Non-Invasive Procedure? – Last Updated on 4/8/2017

Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN

Lev-Ari, A. 5/19/2014. Transcatheter Mitral Valve (TMV) Procedures: Centers for Medicare & Medicaid Services (CMS) proposes to cover Transcatheter Mitral Valve Repair (TMVR)

Transcatheter Mitral Valve (TMV) Procedures: Centers for Medicare & Medicaid Services (CMS) proposes to cover transcatheter mitral valve repair (TMVR)