On July 29, the University of North Carolina Heart Valve team performed North Carolina’s first commercial fully percutaneous transcatheter mitral valve replacement (TMVR). The milestone makes UNC the first hospital in the state to provide the treatment and the only hospital in North Carolina that can offer transcatheter repair and replacement of both the mitral and tricuspid valves.
For patients with complex heart valve disease, having another treatment option could bring meaningful improvements to their quality of life.
Valvular heart disease is becoming an increasing concern as the population ages. A recent study published in the Journal of the American College of Cardiology estimates at least 4.7 million Americans ages 65 to 85 have at least moderate valvular heart disease, while 10.6 million have clinically significant disease.
“Individuals with mitral valve disease typically have significant symptoms, including shortness of breath, swelling in the legs, difficulty breathing at night, and difficulty doing many of the things that they enjoy on a day-to-day basis,” Dr. Matt Cavender, interventional cardiologist with the UNC Heart Valve team said.
Historically, treatment options for mitral valve disease have included medical therapy and surgery. About a decade ago, transcatheter edge-to-edge repair added a less-invasive option, but not every patient is a candidate, and some continue to experience regurgitation. The addition of TMVR gives UNC’s Heart Valve team another option to strategically approach each patient’s needs individually.
The Procedure
The several-hour procedure bringing together interventional cardiologists, cardiac imaging specialists, anesthesiologists, nurses and cardiovascular technologists. Advanced CT and transesophageal echocardiography are used to determine candidacy, plan the procedure and guide placement of the new valve.
“The multidisciplinary expertise, combined with UNC Health’s ability to connect patients across North Carolina with specialized care in Chapel Hill, helped position UNC to be the first center in the state to offer the procedure commercially,” Dr. John Vavalle, medical director for the UNC Heart Valve team said.
To access the mitral valve, the team uses echocardiography to guide a needle from the right atrium through the interatrial septum and into the left atrium. A balloon is then used to create enough space to pass the valve system through. Once inside the left atrium, physicians position a docking system around the existing mitral valve, creating a stable landing zone. The new transcatheter valve is then placed within the dock, which anchors it securely in position.
The procedure can be used to treat mitral valves that do not open fully (mitral stenosis) or mitral regurgitation, when the valve leaks and allows blood to flow backward. Following the procedure, patients typically stay in the hospital for about one day before returning home.
Personalized Valve Care
UNC is recognized by the American College of Cardiology as an accredited valve center, reflecting the comprehensive expertise behind its approach to valve disease. That depth of expertise is matched by the variety of care options available. UNC is equipped to provide medical management, surgical valve repair and replacement, and a growing range of transcatheter interventions across multiple heart valves.
Having those capabilities in one program allows care to be individualized rather than centered around a single procedure. A patient may benefit most from optimizing medical therapy, while another may need transcatheter intervention. For patients with disease affecting multiple valves, the team can also determine which valve to treat first or whether both will ultimately require treatment.
“The addition of this procedure gives the team another option to consider and further strengthens UNC’s ability to match patients with the treatment best suited to their heart health and individual needs,” Dr. Cavender said.