Treatment for Heart Valve Disease that Avoids Open Heart Surgery

We know our bodies change as we age. Some signs of aging can be seen from the outside—our hair turns gray, and our skin wrinkles. Other signs aren’t as visible because they happen inside our bodies.

One common change that can occur with age is that our heart valves don’t work well anymore. This is called heart valve disease, and it affects 1 in 8 people older than 75 in the United States.

What Is Heart Valve Disease?

Your heart has four valves: tricuspid, aortic, mitral and pulmonary. They control the flow of blood to and from your heart to the rest of your body. The valves have leaflets that open and close with each heartbeat.

Sometimes the valves can get damaged and become either too narrow (stenosis) or too loose (regurgitation). When they become too narrow, your heart cannot pump blood out. When they become too loose, blood flows backward through the valve and into the heart. This can lead to too much blood in your heart.

Both conditions put a strain on your heart and cause difficulty breathing, problems with dizziness or fainting, and fatigue.

“We see patients who are profoundly short of breath with low energy, low exercise tolerance. And they’re otherwise healthy, and they want to feel good again,” says UNC Health interventional cardiologist John Vavalle, MD.

Severe heart valve disease can cause more serious conditions including stroke, heart failure and blood clots, so it’s important to get it treated.

Treating Heart Valve Disease

The treatment of heart valve disease depends on the severity of your symptoms and the degree of valve damage. In cases of mild symptoms, your doctor may prescribe medicine such as a beta blocker to slow your heart rate, which reduces the oxygen demand on your heart. However, depending on the severity of your condition, you may need surgery to repair or replace a valve.

For many years, the only surgical option to treat heart valve disease was open-heart surgery. Older patients and those too sick for open-heart surgery had to learn to live with their symptoms, which severely affected their quality of life.

Fortunately, now there are minimally invasive surgical options available, and UNC Health is a national leader in treating heart valve disease through catheters (tubes inserted through the blood vessels) and other minimally invasive techniques that avoid open-heart surgery.

“This is especially important for patients who are not well enough to undergo open-heart surgery,” Dr. Vavalle says. “Patients who historically would be inoperable and have no chance of feeling better now have an opportunity to have their symptoms improved with more minimally invasive approaches.”

The type of minimally invasive procedure done to repair or replace the valve depends on which valve is damaged, the type of damage (too narrow or too loose), and the severity of the damage.

Minimally Invasive Aortic Valve Repair

The aortic valve controls the flow of blood from the heart to the rest of the body. For patients with a narrowed aortic valve, instead of opening the chest to reach the heart, cardiologists use a procedure called transcatheter aortic valve replacement (TAVR) to open and replace the valve.

“We now can repair or replace heart valves through catheters inserted through blood vessels, typically the femoral artery (a large artery in the thigh) or the femoral vein,” Dr. Vavalle says.

Minimally Invasive Mitral Valve Repair

The mitral valve keeps blood flowing in the correct direction between your lower left heart chamber (left ventricle) and your upper left heart chamber (left atrium).

“We can now insert a catheter through blood vessels in the groin to repair a damaged mitral valve,” says UNC Health cardiothoracic surgeon Tommy Caranasos, MD. This procedure is called transcatheter mitral valve replacement (TMVR).

Minimally Invasive Pulmonary Valve Replacement

The pulmonary valve connects the right ventricle to the pulmonary artery. Pulmonary stenosis is a congenital heart defect that occurs when a baby’s pulmonary valve doesn’t grow as it should during the first eight weeks of pregnancy.

Transcatheter pulmonary valve replacement (TPVR) is a minimally invasive treatment for adults with congenital heart diseases who had a procedure to replace their pulmonary valve in childhood.

Minimally Invasive Tricuspid Valve Replacement

The tricuspid valve controls the flow of blood from the heart’s right atrium (top chamber) to the right ventricle (bottom chamber). Severe tricuspid valve regurgitation occurs when a person’s leaflets, the flaps of tissue that open and close to circulate blood, don’t close all the way. Blood then flows back into the heart, causing shortness of breath and swelling of the abdomen, legs or veins in the neck. If left untreated, it can lead to heart, liver and kidney failure.

“It’s a very common problem—one that not only leads to significant symptoms but is associated with a shorter length of life,” Dr. Vavalle says.

Typically, severe tricuspid valve disease would need to be treated with open-heart surgery. However, many patients are too ill to undergo this operation.

“There’s this enormous untreated population who have severe heart failure, severe fatigue, shortness of breath, kidney failure, liver failure as a result of severe tricuspid valve regurgitation,” Dr. Vavalle says.

UNC Health is one of about 50 sites in the U.S. participating in the TRISCEND II clinical trial, which explores a method to perform a minimally invasive transcatheter tricuspid valve replacement. Recently, a team at UNC Health performed the region’s first such procedure.

UNC Health’s Structural Heart Team, including Drs. Vavalle and Caranasos, placed a small catheter tube in a patient’s leg vein. Cardiologists used advanced imaging to reach the heart and implant an EVOQUE tricuspid valve. The device acts as a leaflet would in a healthy heart, opening and closing to let blood through.

“This technology is only available as part of clinical trials. It’s not yet FDA-approved, but we think it will allow us to do a minimally invasive transcatheter tricuspid valve replacement—basically insert a new tricuspid valve into the tricuspid position of the heart,” Dr. Vavalle says. “We think this procedure will not only significantly improve symptoms but will help people live longer and more robust lives.”

If you have questions about your heart health, talk to your doctor. Need a doctor? Find one near you.