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Minimally invasive procedure for valve problems reduces heart failure risk

A study found a minimally invasive procedure significantly reduced heart failure risk among those patients with valves that don't properly connect in the heart. Photo by Photographee.eu/Shutterstock

By Allen Cone, UPI

A minimally invasive procedure significantly reduced heart failure risk among those patients with valves that don't properly connect in the heart, according to a study.

Researchers found patients with moderate-to-severe or severe functional mitral regurgitation have reduced hospitalizations and mortality for heart failure with a transcatheter mitral valve repair. Their findings were published Monday in the New England Journal of Medicine and presented at the annual Transcatheter Cardiovascular Therapeutics conference in San Diego.

"Although some drugs can help alleviate symptoms of functional mitral regurgitation due to heart failure, those therapies are of limited benefit," Dr. Gregg W. Stone, director of cardiovascular research and education at the Center for Interventional Vascular Therapy at NewYork-Presbyterian/Columbia University Irving Medical Center, said in a press release. "To be able to reduce hospitalizations and improve survival is a breakthrough for patients who previously had few treatment options."

With mitral regurgitation, the valve that connects the left ventricle and left atrium in the heart doesn't close completely, forcing the heart to work harder because blood is flowing backward into the heart.

There are two forms of mitral regurgitation. Primary MR is when the valve leaflets or surrounding tissue become damaged. And functional MR, also known as secondary MR, occurs when the left ventricle enlarges after heart damage from any cause, including a heart attack.

The study focused on functional MR.

Although primary MR can be treated effectively with surgical valve replacement or repair, the researchers said there is little evidence that surgical procedures improve outcomes for patients with secondary MR. Instead they are typically treated with drugs that include beta blockers or with pacemakers to regulate heart rhythm.

Nearly one in 10 adults age 75 or older in the U.S. have primary MR. Secondary MR prevalence is uncertain, and is frequently undiagnosed, but is believed to be substantially higher than that of primary MR, the researchers noted.

The study enrolled 614 heart failure patients with moderate-to-severe or severe secondary MR in the United States and Canada for a study between 2012 and 2017. They were symptomatic despite treatment with recommended medical therapies.

Half were treated with MitraClip, which a minimally invasive treatment that fastens the mitral valve leaflets together. Others had medical therapy or medical therapy alone.

The number of heart failure-related hospitalizations and deaths over 24 months in both groups were analyzed.

Patients with the procedure had 47 percent fewer heart failure-related hospitalizations and 38 percent fewer deaths than those only receiving medication.

"The improvement in symptoms and reduction in need for hospitalization due to heart failure was almost immediate after the MitraClip," Stone said. "In contrast, the improvement in survival emerged about a year after the procedure, a delayed response consistent with the long-term benefits of reducing volume overload on the heart."

Also the quality of life and functional capacity were better.

And the treatment was determined to be safe. There were low 30-day rates of death or stroke, and the reduction in MR remained through the two-year follow-up.

"Patients with heart failure and severe secondary or functional MR who remain symptomatic despite all the best medical therapies now have substantially more hope because we can improve their quality of life and survival by reducing their MR with a safe, low-risk procedure," Stone said.

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