A Second Chance: New Procedure Repairs Worn-Out Replacement Mitral Valves

Matthew W. Sherwood, MD, is board certified in interventional cardiology, cardiovascular disease and internal medicine. He practices at the Inova Heart and Vascular Institute. Read Dr. Sherwood’s profile.

Earlier this month, the structural heart team at the Inova Heart and Vascular Institute performed a new procedure to replace a leaky heart valve in an 87-year-old man who had already had a previous valve repair.

The procedure is offered at only about 20 sites in the United States. It’s exciting that we are now one of those sites.

The technique, trans-septal transcatheter mitral valve replacement (or trans-septal TMVR), has a complicated name. But the outcome is easy to understand: Better health and improved quality of life for patients.

Fixing Leaky Heart Valves

Our patient, like many others, had undergone a previous surgery to repair his mitral valve, a parachute-like flap in the heart that allows blood to flow in one direction from the heart’s atrium into the ventricle. That surgery had repaired his mitral valve with a device known as a mitral ring.

While these valve repair procedures are effective, the surgical repair and ring device can wear out after 10 or 15 years.

In this case, our patient’s valve had deteriorated and was allowing blood to leak backwards into the atrium. Because he had heart failure and other medical issues, it wasn’t an option to perform another open surgery to replace or repair the valve again.

With trans-septal TMVR, we were able to insert a tiny tube, or catheter, into the blood vessels of the leg and thread it up to the heart. Once inside, we passed the catheter across the heart’s atrium to reach the mitral valve. Then, we inserted a new replacement valve. It’s a complicated procedure, but it went very well.

Innovative Options

Right now, trans-septal TMVR is only offered to patients who have already had one mitral valve repair or replacement and aren’t candidates for another open surgery. In general, those patients have had no other options ­– until now.

In this procedure, we use a device that was originally designed for replacing the aortic valve. It’s great that we’ve been able to innovate and adapt the device to replace mitral valves as well. But other researchers are now in the process of testing valves specifically designed to replace the mitral valve. We’re hopeful that in the future, we’ll be able to offer an even more customized procedure to patients.

At Inova, our goal is to offer the most innovative, cutting-edge treatments and technologies to our heart patients. That’s part of what makes us one of the top-ranked hospitals in the country for cardiology and heart surgery.

The Structural Heart Disease Team at Inova Heart and Vascular Institute includes:

• Interventional Cardiologists:
  • Shawn Yazdani, MD
  • Matthew Sherwood, MD
  • Nadim Geloo, MD
  • Kelly Epps, MD
  • Joseph Kiernan, MD
  • Hamid Taheri, MD
• Cardiothoracic Surgeons:
  • Liam Ryan, MD
  • Eric Sarin, MD
  • Alan Speir, MD

Learn more about the Inova Heart and Vascular Institute.