New Ways to Repair Heart Valves — Without Open Heart Surgery

Wednesday, July 22, 2009

ROCHESTER, Minn. — New, less invasive ways to repair heart valves may fundamentally transform how this lifesaving procedure is performed. The July issue of Mayo Clinic Health Letter looks at new technologies under study to repair heart valve disorders without open heart surgery.

Two main problems occur with heart valves: narrowing (stenosis) that limits blood flow; and backward leaking (regurgitation), where valve flaps don't close tightly and blood flows in the wrong direction.

Both problems traditionally have been addressed — with good success and safety — via open heart surgery. During surgery, the chest is opened, the heart is stopped, and the valve is repaired or replaced. Recovery can take six to eight weeks.

Researchers are looking at new technologies and techniques that can be done with smaller incisions and without stopping the heart. They include:

• Artificial valve placement via catheter: A collapsible artificial heart valve surrounded by an expanding wire mesh (stent) can be placed via small incisions without stopping the heart. The device is placed via a slender tube (catheter) that's inserted in the groin or in the chest and carefully guided toward to the heart.
• Mayo Clinic is participating in a randomized study comparing outcomes for patients who have standard open heart surgery and those who have an artificial heart valve placed via catheter-based techniques. Results aren't known yet. Researchers do know that when properly placed, the artificial valves are highly effective.
• Tying and tightening valves to stop regurgitation: When tendons around the mitral valve become loose or break, the valve leaflet becomes floppy, allowing regurgitation. A device to repair this malfunction was invented at Mayo Clinic and helps patients avoid open heart surgery. Instead, a slender device is inserted through the chest to the tip of the heart while it's beating. The device grabs the edge of the floppy leaflet, attaches a string and is then removed, along with the string end. The string is tightened and tied to stop regurgitation. A trial of the device is planned to begin this summer in Europe.
• Clipping mitral valve: In many cases, one of the two valve leaflets is floppy and the other one remains healthy. A mitral valve clip is used to staple the two leaflets together at the midpoint. The healthy side supports the flailing side. Clips are inserted via a catheter. Early trials showed this approach may not be as effective as other approaches. A larger study is under way.

For now, open heart surgery will continue to be the mainstay to repair and replace heart valves. As research advances, some less-invasive approaches may be viable alternatives.

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