New device offers new options for mitral regurgitation

Providence cardiologists made local history in early 2014 by performing the first percutaneous mitral valve repair in Oregon.

An 89-year-old patient too medically fragile to undergo open-heart surgery received two MitraClips to repair severe mitral valve regurgitation. Approved by the U.S. Food and Drug Administration in October, the mechanical device is implanted via catheter, which is controlled by a robotic arm that requires two people to operate.

Robert Hodson, M.D., FACC, FSCAI, medical director for Providence Valve Center, and Ethan Korngold, M.D., medical director of cardiovascular research at Providence Heart and Vascular Institute, worked in tandem on this first case. Using transesophageal echocardiograpy and fluoroscopy for guidance, they inserted the catheter via femoral access and guided the device across the mitral valve into the left ventricle. 

Minute adjustments with the robotic arm’s eight knobs allowed the clip to be carefully positioned so it could grasp the anterior and posterior mitral valve leaflets.

“It’s a very complex device,” says Dr. Korngold, “and delivering it requires a lot of precision.”

Once in place, the clip cinches together the leaflets in the center of the regurgitant jet, creating a dual-orifice mitral valve with less regurgitation. There is no need to arrest the heart or perform cardiopulmonary bypass.

In the case of the 89-year-old patient, two clips were placed successfully, and he went on to make a full recovery. Since pioneering the technology in Oregon, Providence Valve Center has treated four more patients with the MitraClip.

Patients with degenerative mitral regurgitation, such as mitral valve prolapsed or flail leaflet, who are at high risk for surgery may be eligible for the device. To determine eligibility, specialists at Providence Valve Center evaluate patients using a targeted transesophageal echocardiography, paying careful attention to the mitral valve leaflets and grasping area.

Providence also is studying functional mitral regurgitation within the COAPT clinical trial. The study is testing the MitraClip repair system in heart failure patients with moderate to severe regurgitation who cannot have valve surgery. The study evaluates the safety and effectiveness of the device compared to aggressive treatment with heart failure medications.

Patient screening and enrollment for COAPT is taking place at Providence St. Vincent and Providence Portland medical centers. Participants will be managed and treated aggressively for heart failure, regardless of treatment assignment.

To learn more about treatment options for mitral regurgitation, including the MitraClip and the COAPT trial, contact Ethan Korngold, M.D., Robert Hodson, M.D., or Providence Valve Center at 503-216-0790.