In a person with heart failure, minimally invasive mitral valve repair surgery, using a device introduced through the arterial route, clearly improves the prognosis of the disease with good tolerance. Explanations.
In patients with heart failure associated with mitral valve dysfunction * (a valve that connects the left ventricle and the left atrium of the heart), a minimally invasive mitral valve repair surgery, using a catheter that is inserted into the heart through the arterial route, significantly reduces hospitalizations and mortality related to this disease, according to a recent study. These results were published in the New England Journal of Medicine.
A controlled study
In the United States and Canada, 614 patients with moderate to severe heart failure were included in the trial and remained symptomatic despite recommended drug therapy. Participants were drawn to receive either the MitraClip device, which fixes the mitral valve leaflets introduced through an arterial catheter, combined with standard medical treatment, or medical treatment alone. The researchers then compared the number of heart failure hospitalizations and deaths over 24 months in the two groups.
Reduced deaths and hospitalizations
Patients who have benefited from the minimally invasive procedure have 47% fewer hospitalizations and 38% fewer deaths, linked to heart failure, than those who are managed with medical treatment alone. The procedure is also associated with significant improvements in quality of life and functional skills.
The treatment is considered safe, with moderate death or stroke rates over 30 days. Likewise, the reduction in mitral regurgitation persisted throughout the study follow-up (2 years).
A new treatment option
“Although certain drugs can improve symptoms of functional mitral insufficiency associated with heart failure, these treatments have limited benefit,” said Dr. Stone, professor of medicine at Vagelos College at Columbia University. “Being able to reduce hospitalizations and improve survival is a major breakthrough for these patients who previously had few treatment options.”
* What is functional mitral insufficiency?
Mitral insufficiency occurs when the valve that connects the left ventricle and the left atrium in the heart does not close completely, allowing blood to flow backward, forcing the heart to work harder to pump blood. and dilate it.
Primary mitral insufficiency occurs when the valve leaflets or surrounding tissue are damaged first. While functional, or secondary, mitral insufficiency occurs when the left ventricle and the valve ring dilate due to a disease of the heart, such as a heart attack.
How is mitral regurgitation treated?
Primary mitral insufficiency can be treated by replacing or repairing the surgical valve. Until now, there has been little evidence that surgery improves the condition of patients with secondary mitral insufficiency. Indeed, these tend to have a more unfavorable prognosis and operative risk and are therefore generally treated only with drugs, such as beta-blockers, or cardiac pacemakers.
A frequent illness
Almost one in ten adults aged 75 or older in the United States suffers from primary mitral insufficiency. The prevalence of secondary mitral insufficiency is uncertain as it is often undiagnosed, but it is believed to be significantly higher than that of primary MRI. “Improvement in symptoms and reduction in hospitalizations for heart failure were almost immediate after placement of the MitraClip device. In contrast, improvement in survival appeared approximately one year after the procedure, a delayed response to long-term overload benefits on the heart, ”Dr. Stone said.
“Patients with heart failure and severe secondary or functional mitral insufficiency, who remain symptomatic despite all the best medical treatments, now have much more hope because we can improve their quality of life and survival by reducing their insufficiency. mitral by safe and low risk intervention “Dr. Stone.
.
