Collaborative team providing options for mitral valve patients

When the mitral valve leaks, it puts stress on the heart and lungs, which must work harder to pump blood throughout the body. This causes breathlessness and over time, the heart enlarges and progresses to heart failure.

Fortunately, mitral valves can be repaired. In Calgary, surgeons repair about 200 mitral valves each year through conventional open-heart surgery or using minimally invasive techniques via a small incision in the chest wall. But thanks to a partnership between cardiology, cardiac surgery, nursing and anesthesiology, local patients have another option called transcatheter edge to edge repair (TEER).

No incision is used in the TEER procedure, which involves using a catheter to insert a tiny clip-like device, called MitraClip, through the heart’s septum. The clip is used to repair the leaking valve, which is located between the left atrium and the left ventricle.

According to Calgary heart surgeon Dr. William Kent, TEER technology is continuing to evolve, and although it was introduced briefly in Alberta many years ago, there has not been a program in Alberta until now. The first cases took place in November 2023 in the Cardiac Hybrid Operating Room at Foothills Medical Centre.

“It’s a very safe procedure with minimal risk and is effective with impressive long-term outcomes for carefully selected patients” says Kent.  “It is a better procedure for many of our patients. After traditional surgery, they are in the hospital for a better part of a week and in recovery for up to 12 weeks. With TEER, they are back home in a day and regain functional status in less than a week.”

Interventional cardiologist Nishant CSharma, MD, who has trained in several centres, brings important expertise to the group. “The complex part of the procedure is crossing the septum and deploying the device,” says Sharma.

Recognizing the importance of teamwork, cardiac surgeon, Dr. Corey Adams, MD, suggests the hardest part of the procedure is patient selection, explaining it depends on their age, the complexity of their condition and on their anatomy.

“A collaborative clinic has been established to assess patients with mitral valve disease,” says Adams.

“Combining the surgical perspective, the interventional cardiology expertise in fluoroscopy and transcatheter skills with the echo imaging ability of cardiology and anaesthesiology, allows us to place the clip in the correct position for optimal results.”

Interventional cardiologist Dr. Michael Curtis, MD, who directs the Cardiac Catheterization Lab at the Foothills Medical Centre, and leads the Interventional Cardiology group, says collaboration is key in the success of this program.

“Many experts from multiple specialities, including nursing, imaging and physiotherapy, are involved in caring for these patients before, during and after the procedure,” he says.

The team is piloting the technology for approximately 20 patients over this first year of the program.