Dr. James McCabe demonstrates a MitraClip that resembles a clothespin, as he did from John Steenmeyer via a catheter heart. Image credit: UW Medicine Photo
Cardiologists at the UW Medicine Heart Institute recently performed a world-first procedure to remove and retrieve a clamp device from a patient’s mitral valve and place a replacement biological Valves – all through the catheter. Previously, this array of tasks could only be performed through open surgery.
Patient John Steenmeyer, 76, of Bellingham, WA, received this week from the University of Washington Medicine Center for Discharge in Seattle. His new mitral valve is functioning well, said Dr. James McCabe, who led the catheterization procedure on April 27.
Over the years, Steenmeyer’s energy has declined due to a gap between the two leaflets of his mitral valve A poor seal causes blood to leak backward into the left atrium. This “regurgitation” is a common heart valve problem that people can live with for years in mild cases, but requires medical intervention in severe cases.
“It had a huge impact on my life,” Steenmeyer said of his failed valve. “It got to the point where there was nothing I could do with the cadets,” he said, referring to his role as commanding officer of Whatcom County Sea Cadet, a U.S. Navy-sponsored youth development program.
In 2021, his Bellingham cardiologist determined he couldn’t wait any longer and the surgery was risky too big. Steenmeyer underwent catheter-based surgery to implant the MitraClip, a clothespin-like device that pulls the two flapping leaflets of his mitral valve together to improve their seal. Alas, it wasn’t long before his doctor realized the clip wasn’t enough to reduce the leak.
In August 2022, he was referred to UW Medicine. “I was ready to make my will,” Steenmeyer said, “so this came at the perfect time.”
McCabe says he often gets calls from area cardiologists, “‘Hey, we don’t know what to do with a patient. Can you help? So we’re starting with a very open script.”
His first thought was that, like other patients in this situation, Steenmeyer might benefit from an extra MitraClip.
Patient A’s mitral valve clip device (right side) is sheathed and pulled into the oven, then removed through the catheter. The torch of tissue at the top of the clip is part of the mitral valve leaflet. A bioprosthetic valve was subsequently implanted in this patient. Image Credit: Dr. James McCabe/UW Medicine Heart Institute
“You can stack them, but you also have to consider: how small do you open the valve? There is a point of inflection where you can make the valve too small, and then You’re trading leaks for stenosis [excessive stenosis] and other problems.”
Ultimately, Steenmeyer Mitral The calcium deposits on one side made the decision for McCabe: because they would continue to expand and shrink the valve’s circumference, no additional MitraClips could be placed. It was subsequently confirmed that Steenmeyer was inoperable for surgery, seemingly exhausting his options.
McCabe contacted Edwards Lifesciences, a company that manufactures replacement valves. One of its new devices, a catheter-placed mitral valve, is currently being tested in a national clinical trial. McCabe is UW Medicine’s principal investigator on the trial.
He asked Edwards if he could be considered if there was a way to remove Steenmeyer’s MitraClip without surgery Make a test device? The answer is yes; Steenmeyer can’t be included in the trial, but could get the test valve if the FDA grants a compassionate use exemption.
It took six months to get approved. “During that time, we developed a plan based on our experience over the last year,” said McCabe, describing another first-of-its-kind catheter procedure in which a benign tumor is removed from the inner wall of a patient’s heart using electrocautery. It is cut open and removed during surgery. small basket.
He described Steenmeyer’s procedure: “We cut the leaflets on the back and when we grabbed the clip , we cut the front leaflet and pulled it back into this basket. We had to pull it from the left atrium through the wall between the two atria where we made a hole into the vena cava A big sheath, and we take it off.
“We just want to do it for people who can’t operate Emulating the surgery,” said McCabe. Glad Mr. Steenmeyer is doing well.” McCabe confirmed knowing the previous procedure involved their device and catheter-based MitraClip extraction in the clinical trial.
Gabriel Aldea, MD, and David Elison, MD, McCabe Washington University Medicine Heart Institute and Bailey Benton, Cardiovascular Technologist Assisted in the operation.
Citation: strength, stick to yield first-anywhere heart surgery (2023, May 12) retrieved May 28, 2023 from https://medicalxpress.com/news/2023- 05-prowess-persistence-yield-first-anywhere-heart.html
This document is protected by copyright. Except for any fair dealing for private study or research purposes, no part may be reproduced without written permission. The content is for reference only.
