November 3, 2003

Block performs world's fifth repair of heart valve

By Cindy Sanders

Richard Kraus knew for a couple years that one of his heart valves needed repair. When he began to feel winded from walking up the small hill in front of his Stone Mountain home, Kraus' doctor told him his heart's mitral valve was leaking and he would continue to feel weakened until the problem was fixed.

Until recently, his only course of treatment was open heart surgery, a major procedure that could take several months of recovery time. That is until he met Emory cardiologist Peter Block.

Block performed the world's fifth nonsurgical repair of the mitral valve on Kraus, 75, in early September at Emory Hospital. The innovative procedure uses a catheter to attach a tiny metallic clip to a leaking mitral valve, which separates the left upper and lower chambers of the heart.

The procedure may eliminate the need for open-heart surgery in some patients, like Kraus, who suffer from significant mitral valve regurgitation,    a progressive, long-term disorder in which the mitral valve does not close properly, causing the heart to work harder as blood leaks backward. It affects some   4 million people in the United States, and about 250,000 develop significant mitral regurgitation each year.

Patients eventually become so weakened by the condition that they require open-heart surgery to replace or repair the damaged mitral valve. About 44,000 Americans undergo open-heart surgery annually for mitral-valve repair.

The new procedure is minimally invasive. Under full anesthesia, a catheter (a thin, flexible plastic tube), introduced through the skin in the thigh area, is guided through the femoral vein into the affected area of the heart. A smaller delivery catheter that holds the implantable clip is slipped through this tube, so the clip can be guided into place and attached to the leaflets (the "swinging doors") of the mitral valve. Once the clip is securely attached, the delivery catheter is removed.

The entire process is monitored by an echocardiogram, and patients usually return to normal activity within a few days.

The procedure is under an FDA-approved investigational device exemption and has been performed on only five patients worldwide. It will be under the FDA exemption through the 10th patient and then will enter clinical trials.

"The results are showing promise that open heart surgery will not be the only option for patients suffering from mitral valve regurgitation," said Block, professor of medicine. "There are many benefits--it is much less invasive since it is done through a catheter, and recovery time is quicker."

To be eligible for the investigational procedure, candidates must have moderate to severe mitral regurgitation and be experiencing symptoms (fatigue, chest pain, shortness of breath); or, lacking these symptoms, they must have a weakened left ventricle.

Before his procedure, Kraus had to stop walking halfway up his driveway to catch his breath. Today he can jog the small hill with no problems.

"This was a good alternative for me," he said. "I am very happy I didn't have to undergo open heart surgery, and the recovery time has been short. I would recommend this to anyone."