A complication of cardiac valve replacement, paravalvular leaks (PVL) resulting in blood escaping from around the valve can cause anemia or congestive heart failure and may be life threatening. Due to age or medical conditions, many patients are not suitable candidates for open heart surgery to close the leak.

 

Two months ago, Holy Cross Hospital was the first in the state to perform a paravalvular leak closure using a transapical approach.

 

Having undergone three previous open heart operations, the patient had been aware of the PVL for approximately one year and was increasingly experiencing shortness of breath. The dehiscence of her valve from the surrounding heart tissue had left a gap of approximately 30 percent of the circumference of the mitral valve. The transapical approach repair procedure offered a quicker recovery and better outcome possibilities than a fourth open heart surgery.

 

The hybrid cardiac repair required the collaboration of interventional cardiologists, structural heart cardiologists and cardiac surgeons. The surgical team included myself, Holy Cross cardiothoracic surgeon Irving David and Dr. Vincent Font, an expert in echocardiography, which was used to guide the procedure and confirm the repair.

 

Joining us was Dr. Igor F. Palacios, Director of Interventional Cardiology at Massachusetts General Hospital. This built upon a collaborative agreement begun in 2010 between Holy Cross and Massachusetts General Hospital, one of the world’s most distinguished academic medical centers. I am personally aware of Massachusetts General’s advances in cardiac care having fulfilled an interventional cardiology fellowship and an advanced coronary and structural heart disease fellowship there during my training. One of the goals of this collaboration is to continue to bring cutting edge cardiovascular techniques such as these to Florida.

 

Dr. David gained surgical access to the heart through an incision made between the ribs of the lower left chest that enabled the placement of a sheath into the apex of the heart. With the sheath acting as an access port and guided by 3D-TEE, I was able to utilize guidewires and catheter techniques to place the wire across the leak and deliver an Amplatzer PDA occlude device to close the PVL. After 3D-TEE confirmed the closure, the sheath was removed and the incision surgically closed by Dr. David.

 

The procedure took 2.5 hours and the expected outcome is that the procedure closed 95 percent of the PVL with the remaining five percent expected to close as a small layer of skin grows around the repair over the subsequent months.

 

The operation took place in Holy Cross Hospital’s new 2,000 square-foot hybrid interventional operating room, which contains advanced technology enabling leading-edge procedures including transcatheter aortic valve replacement (TAVR); endovascular stent (abdominal & thoracic); surgical pacemaker lead extraction; surgical cardiac ablation; minimally invasive bypass of the left anterior descending artery with concomitant percutaneous coronary intervention of the right coronary and left circumflex; minimally invasive surgical valve replacement with concomitant coronary intervention; high risk coronary intervention with percutaneous ventricular assist device support and ASD, PDA & PFO closures.

 

Repairing PVLs through the minimally invasive transapical approach which allows for a faster procedure and reduced recovery times offers a new option for patients not suitable for open heart surgery.