First right heart valve repaired by catheter

No major surgery with defective right heart valve?

09/25/2014

For the first time doctors have been able to repair the defective right heart valve of a patient with a catheter, as the Albertinen Hospital reports. The 89-year-old woman survived the procedure well and quickly recovered on the following days. So far, an open heart surgery is necessary to repair the so-called tricuspid valve. Especially with very sick and elderly patients, such an intervention is associated with high risks.

Right heart valve can be repaired by catheter without loading surgery
The catheter procedure was successfully performed on 18 September 2014 by Prof. Joachim Schofer, Head of the Department of Percutaneous Treatment of Heart Valve Diseases at the Heart and Vascular Center of the Albertinen Hospital. In the patient, the tricuspid valve was reconstructed between the right atrium and the right ventricle. Already on Thursday, the 89-year-old left the clinic again, as the online edition of „Hamburger Abendblatt“ reported. „I'm fine, I can now sleep well and move well, I'm happy that the professor has done it, "said Gerda Freytag to the newspaper. „The patient survived the procedure well and quickly recovered from it the following days“, also confirms the Albertinen Hospital.

The patient was already suffering from significant heart problems, so that an open-heart surgery would have been too stressful for her. The doctors around Prof. Schofer therefore consulted extensively on the case to find a safer alternative treatment method, and decided on the procedure with the catheter, which is already successfully used in the reconstruction of the mitral valve between left atrium and left ventricle. „The 89-year-old patient suffered from a severe, otherwise untreatable heart failure“, informs the clinic.

Often, other heart ailments are based on defective right heart valves
In the so-called tricuspid regurgitation, in which Gerda Freytag fell ill, the right heart valve is leaking, so that at each heartbeat blood flows back into the atrium and dammed back into the body. The patient suffered from water retention in the legs as well as liver and kidney damage. Not infrequently, the disease is the result of another heart condition. „A constriction of the aortic valve between the left ventricle and the main artery or a leak in the mitral valve between the left atrium and the left ventricle leads to a congestion, which can continue into the right ventricle and then leads to the expansion of the heart, "explains Prof. Friedrich-Christian Rieß, Head of Cardiac Surgery and Chairman of the Heart and Vascular Center at the Albertinen Hospital, opposite the Journal, this dilation also causes the tricuspid valve ring to widen so that the valve can not close completely.

During the procedure, the doctors used a technique that is also used in open heart surgery. The flap, which is made up of three sails, is so greatly reduced by gathering that it has only two sails after the intervention. In the case of the new catheter procedure, heart valve reconstruction was performed on the beating heart without interrupting the circulation. „Via the jugular vein, a catheter is pushed into the right ventricle. There, an anchor is attached to each side of the rear damper. With threads and the help of a catheter, these anchors are pulled together, "Prof. Schofer explains to the newspaper, reducing the size of the flap ring so that the flaps close again. „This opens up a treatment perspective for many patients who could not previously be helped. "For very ill and weakened patients, open surgery poses a high risk. Experts assume a mortality of 20 percent for advanced disease.

The new procedure with catheter must first be tested in studies
Two years passed before the catheter procedure could be used. „The process will be further modified and simplified. This is the prerequisite for carrying out a study with 30 to 50 patients in Europe, "explains Schofer, adding that hospitals in the US have already expressed their interest. „One has to wait another two years for the procedure to come onto the market.“ For the 89-year-old doctors needed four hours for the procedure. „Because we were in a previously unknown area. I'm sure the next surgery will be two hours shorter, "adds Schofer.

The costs of the procedure are still not covered by the health insurance companies. „Such an intervention is not yet reflected in the DRG billing system case flat rates, "explains Cord Meyer, chief executive of the Albertinen Diakoniewerk, to the newspaper, adding that the extra costs must now be borne by the hospital.

Reconstruction of the right heart valve medium catheter especially for very sick patients
Catheter surgery may be the only treatment option for many patients with severe tricuspid regurgitation. „Many patients have already undergone heart surgery (aortic or mitral valve surgery or bypass surgery) or are at advanced age, so reoperation is associated with a high risk. For this reason, only the drug therapy remained for these patients, but the cause can not be eliminated and the course of the disease can not be significantly influenced“, informs the hospital. In Europe and the US, about four million people are affected by relevant tricuspid regurgitation. Every year, around 500,000 new patients are added. (Ag)