Minimally invasive techniques for repairing heart valves are now available for patients who aren't candidates for traditional heart surgery.
Interventional cardiologist Dr. Scott Lim, co-director of the UVA Cardiac Valve Center, discusses some of the less-invasive options available to patients.
Dr. Lim is part of a heart valve treatment team that includes cardiologists, heart surgeons, clinical researchers and nurses who specialize in treating and caring for patients living with heart valve disease.
Selected Podcast
Latest Options for Heart Valve Repair
Featured Speaker:
Organization: Cardiac Valve Center
Dr. Scott Lim
Dr. Scott Lim is co-director of UVA's Cardiac Valve Center and is noted internationally for his expertise in novel percutaneous approaches to heart valve disease. He specializes in children and adults with congenital heart disease. Dr. Lim is also the co-director of the Adult Congenital Heart Disease Center at UVA.Organization: Cardiac Valve Center
Transcription:
Latest Options for Heart Valve Repair
Melanie Cole (Host): Minimally invasive techniques for repairing heart valves are now available for patients who aren't necessarily candidates for traditional heart surgery. My guest is Dr. Scott Lim. He's the co-director of UVA's Cardiac Valve Center, and he's noted internationally for his expertise in novel percutaneous approaches to heart valve disease. Welcome to the show, Dr. Lim. Speak about what cardiac valve disease is with a little bit of a lesson for us on what valves do.
Dr. Scott Lim (Guest): Sure. First of all, I'm honored to be on this segment here. Now, as far as what heart valve disease is, all of us have four valves in our hearts. They help regulate the flow of blood through the heart and out to the body. Most commonly, two of the valves on the left side heart can, in certain people, strictly as we get older, cause problems. Now, the most common problem is either that the valve itself doesn't completely open, and as such, the heart is under a lot more stress and strain as it's trying to pump the blood past a narrowed heart valve. Most commonly, that's something called aortic stenosis, which can affect many people as they get older. Another common problem is a valve doesn't completely close so that the blood can leak backwards, particularly towards the lungs, giving a patient the sensation of increasing shortness of breath, particularly with activity. Those are probably the two of more the common types of heart valve issues plaguing people as they get older.
Melanie: So you certainly don't want blood backing up or going back into the lungs. We want it really strongly pushed out through that left ventricle out into the body. So the valves that you mentioned on the left side that typically have issues, what are some reasons that they would have these issues? Are there symptoms, Dr. Lim, that might signal that you've got some kind of -- you know, do you have shortness of breath? What might people feel?
Dr. Lim: Sure. From a patient's standpoint, the most common symptom that they would feel is increasing shortness of breath with activity, with exercise. Other potential symptoms can be chest pain or chest tightness or palpitations or raising heartbeat. Now, the most common reason why the valve is failing this way is related to age-type changes. For some Americans, as they get older, into their '70s and older, they can have degeneration of these valves as we're all living longer and, as a result, those valves start malfunctioning. Less commonly, it can also be due to an abnormality or a birth defect to the valve that was present since birth but then really starts to become more of a problem as the person gets older.
Melanie: People picture these valves, Dr. Lim, and I know that in graduate school that's how I pictured them, as something you might see on a car that prevents that back flow. They're these so important bit of our heart and bits of our body. Now, if somebody does have a problem with the valve and you need to help them, what are the treatment options available at UVA in the cardiac valve center? What are you doing for them?
Dr. Lim: Sure. Probably the most important thing is, first of all, the evaluation of it, because not everything has to require a replacement or repair, something more invasive. So when the patients first come to us, they get a multidisciplinary approach. They get to see cardiologists involved in imaging their heart valve through ultrasound or CAT scan or MRI and so forth. They also get to meet with specialists in deciding what's the proper therapy, as well as the surgeon or the cardiologist involved in doing that therapy. Now, if it turns out that the patient has a significant heart valve problem, in most cases, medicines are not effective for that. In most cases, you have to either repair the valve or replace the valve. Traditionally, that's been something that's only been done by a relatively invasive open-chest, open-heart surgery type of approach. More recently, we've done a lot of work allowing research, as well as coming into the forefront of medical care, of how to repair or replace valves through catheters. Small tubes are inserted into the blood vessels in either the leg to the side of the body. That's really allowed a less invasive approach for many people, allowing them to undergo such procedures that may not have been warranted for them in the past, as well as allowing them to heal up much quicker than a more traditional, more invasive approach.
Melanie: And minimally invasive in these trans-catheter procedures, what are you doing when you repair versus changing the whole valve?
Dr. Lim: When we're repairing a valve, a good example is a valve that's leaking. There is the traditional way, which involves opening up the chest and opening up the heart, stopping the heart, looking at the valve, and trying to figure out where and how we can put in a series of stitches on the valve. A less invasive way to doing it, or a trans-catheter based way to do it, is using tiny little metal clips called MitraClips that are introduced through a catheter and then placed onto the leaking part of the valve, clipping it back together. This is all done with the catheter while the heart is still beating, while the chest is still closed, and it's guided by the use of ultrasound so that we can see what we're doing.
Melanie: That is so cool. Is this a lifetime thing, or is there a possibility later that they might need the valve replaced?
Dr. Lim: The goal with this is a lifetime repair. However, many of these newer technologies have not been in existence for an entire lifetime. So we may have eight or 10 ten years of experience on it, but we certainly don't have 40 or 50 years of experience, so we don't really know that answer. We think it is a permanent repair, and we certainly hope so. That still has yet to be proven.
Melanie: Recovery time for the trans-catheter, more minimally invasive, and then we'll talk about a full replacement.
Dr. Lim: Sure. So in terms of a trans-catheter repair of a valve using some of these MitraClip type procedures, that's commonly done where the patient comes in, gets the procedure, we watch them one or two days in the hospital, and then they're able to head home and resume more normal activities. Now, instead of repairing the valve, we're replacing it. Much of the time, that depends on how we do it, but oftentimes the patients are in the hospital maybe three or four days on average compared to if they underwent a standard open-chest, open-heart surgical approach, where they'd be in the hospital a week or slightly longer.
Melanie: And if you have to replace the entire valve, then -- we only have a couple of minutes left, but what's involved in that?
Dr. Lim: Sure. What that is is we take almost the same valve that's inserted by a standard open-chest surgery. Instead, we compress it down so it can then go through that catheter from the blood vessel in the leg or the side of the body, and we spread that up into the heart, where, as it comes out of the catheter, we re-expand it into the normal size. It pushes aside the old malfunctioned valve and starts working right away.
Melanie: Wow. That is fascinating. And then recovery, if you've had a valve replaced, aortic valve, a mitral valve, what can they look for for the rest of their life? Is this something that really is a new lease—no more shortness of breath? Pretty exciting.
Dr. Lim: It is very exciting, and yes, that is the goal that the patient's main symptoms that got them there in the first place, be it shortness of breath or chest pain, that the patient has resolution of those symptoms.
Melanie: So give us your best advice for cardiac valve disease in the last one minute, Dr. Lim, if you would.
Dr. Lim: Sure. I think one of the most important things is that this whole field of heart valve disease is rapidly changing. There's a lot of really new, exciting things available and on the horizon. So it's very important for a patient with heart valve disease not only get an opinion from a cardiologist, a physician they trust, but in certain cases, it's worth seeking out a second opinion from a center that has a lot of experience in these newer things.
Melanie: Thank you so much. Dr. Scott Lim is the co-director of UVA's cardiac valve center, and he's noted internationally for his expertise in novel percutaneous approaches to heart valve disease. You're listening to UVA Health System Radio. For more information on the cardiac valve center at UVA, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening.
Latest Options for Heart Valve Repair
Melanie Cole (Host): Minimally invasive techniques for repairing heart valves are now available for patients who aren't necessarily candidates for traditional heart surgery. My guest is Dr. Scott Lim. He's the co-director of UVA's Cardiac Valve Center, and he's noted internationally for his expertise in novel percutaneous approaches to heart valve disease. Welcome to the show, Dr. Lim. Speak about what cardiac valve disease is with a little bit of a lesson for us on what valves do.
Dr. Scott Lim (Guest): Sure. First of all, I'm honored to be on this segment here. Now, as far as what heart valve disease is, all of us have four valves in our hearts. They help regulate the flow of blood through the heart and out to the body. Most commonly, two of the valves on the left side heart can, in certain people, strictly as we get older, cause problems. Now, the most common problem is either that the valve itself doesn't completely open, and as such, the heart is under a lot more stress and strain as it's trying to pump the blood past a narrowed heart valve. Most commonly, that's something called aortic stenosis, which can affect many people as they get older. Another common problem is a valve doesn't completely close so that the blood can leak backwards, particularly towards the lungs, giving a patient the sensation of increasing shortness of breath, particularly with activity. Those are probably the two of more the common types of heart valve issues plaguing people as they get older.
Melanie: So you certainly don't want blood backing up or going back into the lungs. We want it really strongly pushed out through that left ventricle out into the body. So the valves that you mentioned on the left side that typically have issues, what are some reasons that they would have these issues? Are there symptoms, Dr. Lim, that might signal that you've got some kind of -- you know, do you have shortness of breath? What might people feel?
Dr. Lim: Sure. From a patient's standpoint, the most common symptom that they would feel is increasing shortness of breath with activity, with exercise. Other potential symptoms can be chest pain or chest tightness or palpitations or raising heartbeat. Now, the most common reason why the valve is failing this way is related to age-type changes. For some Americans, as they get older, into their '70s and older, they can have degeneration of these valves as we're all living longer and, as a result, those valves start malfunctioning. Less commonly, it can also be due to an abnormality or a birth defect to the valve that was present since birth but then really starts to become more of a problem as the person gets older.
Melanie: People picture these valves, Dr. Lim, and I know that in graduate school that's how I pictured them, as something you might see on a car that prevents that back flow. They're these so important bit of our heart and bits of our body. Now, if somebody does have a problem with the valve and you need to help them, what are the treatment options available at UVA in the cardiac valve center? What are you doing for them?
Dr. Lim: Sure. Probably the most important thing is, first of all, the evaluation of it, because not everything has to require a replacement or repair, something more invasive. So when the patients first come to us, they get a multidisciplinary approach. They get to see cardiologists involved in imaging their heart valve through ultrasound or CAT scan or MRI and so forth. They also get to meet with specialists in deciding what's the proper therapy, as well as the surgeon or the cardiologist involved in doing that therapy. Now, if it turns out that the patient has a significant heart valve problem, in most cases, medicines are not effective for that. In most cases, you have to either repair the valve or replace the valve. Traditionally, that's been something that's only been done by a relatively invasive open-chest, open-heart surgery type of approach. More recently, we've done a lot of work allowing research, as well as coming into the forefront of medical care, of how to repair or replace valves through catheters. Small tubes are inserted into the blood vessels in either the leg to the side of the body. That's really allowed a less invasive approach for many people, allowing them to undergo such procedures that may not have been warranted for them in the past, as well as allowing them to heal up much quicker than a more traditional, more invasive approach.
Melanie: And minimally invasive in these trans-catheter procedures, what are you doing when you repair versus changing the whole valve?
Dr. Lim: When we're repairing a valve, a good example is a valve that's leaking. There is the traditional way, which involves opening up the chest and opening up the heart, stopping the heart, looking at the valve, and trying to figure out where and how we can put in a series of stitches on the valve. A less invasive way to doing it, or a trans-catheter based way to do it, is using tiny little metal clips called MitraClips that are introduced through a catheter and then placed onto the leaking part of the valve, clipping it back together. This is all done with the catheter while the heart is still beating, while the chest is still closed, and it's guided by the use of ultrasound so that we can see what we're doing.
Melanie: That is so cool. Is this a lifetime thing, or is there a possibility later that they might need the valve replaced?
Dr. Lim: The goal with this is a lifetime repair. However, many of these newer technologies have not been in existence for an entire lifetime. So we may have eight or 10 ten years of experience on it, but we certainly don't have 40 or 50 years of experience, so we don't really know that answer. We think it is a permanent repair, and we certainly hope so. That still has yet to be proven.
Melanie: Recovery time for the trans-catheter, more minimally invasive, and then we'll talk about a full replacement.
Dr. Lim: Sure. So in terms of a trans-catheter repair of a valve using some of these MitraClip type procedures, that's commonly done where the patient comes in, gets the procedure, we watch them one or two days in the hospital, and then they're able to head home and resume more normal activities. Now, instead of repairing the valve, we're replacing it. Much of the time, that depends on how we do it, but oftentimes the patients are in the hospital maybe three or four days on average compared to if they underwent a standard open-chest, open-heart surgical approach, where they'd be in the hospital a week or slightly longer.
Melanie: And if you have to replace the entire valve, then -- we only have a couple of minutes left, but what's involved in that?
Dr. Lim: Sure. What that is is we take almost the same valve that's inserted by a standard open-chest surgery. Instead, we compress it down so it can then go through that catheter from the blood vessel in the leg or the side of the body, and we spread that up into the heart, where, as it comes out of the catheter, we re-expand it into the normal size. It pushes aside the old malfunctioned valve and starts working right away.
Melanie: Wow. That is fascinating. And then recovery, if you've had a valve replaced, aortic valve, a mitral valve, what can they look for for the rest of their life? Is this something that really is a new lease—no more shortness of breath? Pretty exciting.
Dr. Lim: It is very exciting, and yes, that is the goal that the patient's main symptoms that got them there in the first place, be it shortness of breath or chest pain, that the patient has resolution of those symptoms.
Melanie: So give us your best advice for cardiac valve disease in the last one minute, Dr. Lim, if you would.
Dr. Lim: Sure. I think one of the most important things is that this whole field of heart valve disease is rapidly changing. There's a lot of really new, exciting things available and on the horizon. So it's very important for a patient with heart valve disease not only get an opinion from a cardiologist, a physician they trust, but in certain cases, it's worth seeking out a second opinion from a center that has a lot of experience in these newer things.
Melanie: Thank you so much. Dr. Scott Lim is the co-director of UVA's cardiac valve center, and he's noted internationally for his expertise in novel percutaneous approaches to heart valve disease. You're listening to UVA Health System Radio. For more information on the cardiac valve center at UVA, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening.