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6.02.2015

UM Hospital Performs First Mitral Clip Procedure

On May 11, a UHealth surgical team led by Eduardo de Marchena, M.D., professor of medicine and surgery, performed University of Miami Hospital’s first mitral clip procedure — a new, minimally invasive method of reducing mitral regurgitation in patients who are not good candidates for conventional surgical repair.

Mitral regurgitation, or MR, occurs when the heart’s mitral valve does not close properly, causing blood to leak from the left ventricle back into the left atrium. This abnormal reversal of blood flow is a condition found in patients of all ages but most commonly in older adults. Left untreated, MR tends to become progressively worse. In chronic and advanced stages, it is associated with heart failure, breathlessness and poor patient outcomes.

“Many adult patients can be treated successfully with conventional surgery, but about 50 percent are not offered surgery because of age and co-morbidities,” said de Marchena, who is also Director of Interventional Cardiology and Associate Dean for International Medicine. “For them, the outlook is grim.”

The mitral clip procedure, which is performed under anesthesia, is a transseptal approach in which a catheter is run up the femoral vein into the interior vena cava. The catheter, which is guided using both x-ray and transesophageal echocardiography technologies, delivers the clip. When the clip is in place, it closes the valve in the middle, turning the large opening into two smaller openings, one on either side. The procedure can be seen in a video here.

“The mitral clip doesn’t eliminate the condition totally, but it decreases it significantly,” said de Marchena. “It’s not curative, but palliative in advanced patients. Nor will this replace surgery; in younger patients, surgery will still be the preferred treatment. Now, however, we have an option for patients who before couldn’t be treated.”

A perfect example is UM Hospital’s first patient to undergo the mitral clip procedure — an 89-year-old woman with extreme shortness of breath who was referred by cardiologist Roberto A. Miki, M.D., assistant professor of medicine. She remained in the hospital four days and was already feeling markedly better before being released. Her condition should continue to improve with ongoing therapy, said de Marchena.

The procedure requires two operators, and de Marchena’s partner was Mauricio G. Cohen, M.D., associate professor of medicine and Director of the Cardiac Catheterization Laboratory at UM Hospital. Other members of the team included Martin S. Bilsker, M.D., associate professor of medicine, who performed the echocardiography, and Gian Paparcuri, M.D., assistant professor of clinical anesthesiology, who was the cardiac anesthesiologist. Roger Carrillo, M.D., assistant professor of surgery, backed up the team in case the mitral clip procedure needed to be replaced by conventional surgical correction.

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