MDNews - Greater Kansas

STRUCTUR AL HE ART DISE A SE IS THE NE WEST FIELD OF INTERVENTIONAL CARDIOLOGY TO OFFER HOPE TO MANY E X TREMELY SICK PATIENTS WHO ARE NOT CANDIDATES FOR SURGERY WHILE REDUCING RECOVERY TIME FOR THOSE WHO ARE CANDIDATES. Future Horizons and New Hopes For Complex Patients By Zaher Fanari, MD, FACC, FSCAI Medical Director, Structural Heart Disease at Wesley Medical Center Interventional Cardiologist, Structural & Endovascular Specialist, Heartland Cardiology THE FIELD OF structural interventional ca rdiolog y wa s f irst developed w ith tra nscatheter ba lloon dilation of the mitral valve, followed by the introduc- tion of new catheter-based techniques to close congenital defects like atrial septal defects (ASD) and patent foramen ovale (PFO). Since the launch of transcatheter aortic valve replacement (TAVR) therapy around 15 years ago, the field has been in continuous progression. Each generation of TAVR, as well as the continuous devel- opment and addition of new technologies, like MitraClip and transcatheter mitral valve replacement (TMVR) for patients with mitral valve disease, keep adding new horizons and oering more hope for the thousands of patients who need urgent and complex care. TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TAVR has proven to be a great approach that is superior to medical therapy for patients who are not candidates for sur- gery. It also provides a less-invasive and equally eective alternative to surgery for patients of advanced age and those with medical problems and defined as high and intermediate risk. Many trials are currently underway to see if TAVR should be used in all aortic stenosis patients. Women with all types of risk profiles are showing especially promising results. Patients who undergo TAVR usually recover faster a nd leave the hospita l within a few days of the procedure. In most cases, they are able to return home and spend time with family instead of going to a rehabilitation facility. TAVR oers a faster route to get patients back to their normal lives. MITRACLIP Another future development in struc- tural heart disease is the introduction of MitraClip. MitraClip is a new catheter- based procedure that provides an option for patients with severe mitral regurgita- tion (leaking of the mitral valve). This procedure works by pulling the two parts of the valve together and making the leak less significant. Although MitraClip does not replace the valve like TAVR does, it still oers a great opportunity for patients to breathe better and live their daily lives without having to suer. In many cases, the MitraClip allows the heart systolic to recover and get stronger. TRANSCATHETER MITRAL VALVE REPLACEMENT (TMVR) Another great development, TMVR, is similar to TAVR . TMVR oers a less- invasive approach for valve replacement in patients with severe mitral stenosis and regurgitations. Even older technolog ies li ke PFO closure are again gaining new grounds. A f ter yea rs of controversy about the possible benefit of PFO closure in stroke prevention, many emerging trials now show PFO offers a great potentia l for protecting patients with TIA or those at higher risk of stroke from recurrent events. Left atrial closure with either WATCHMAN or AMPLATZER Amulet also oer similar hope to protect against stroke in high-risk patients with atrial fibrillation who are not candidates for long-term anticoagulation. Although many of these procedures are new and emerging without long-term data, they are helping patients on daily basis and oer a chance for improved quality of life or protection from potential disabilities that may worsen it. In many cases these procedures, especially TAVR, oer real lifesaving options. Despite all the growth in this excit- ing field, it was estimated in 2013 that only 25 percent of potential patients who may benefit were getting referred. This deprives ma ny patients from impor- tant care that is widely available. This deficiency can hopefully improve with better communication between structural programs and the physician referral base. This communication, coupled with the continuous improvement in structural procedures and their outcomes, will hope- fully encourage primary care providers, hospitalists and general cardiologists to consider structural clinics as a resource to help deliver much-needed care for vulner- able and complex patient populations. ■ STRUCTURAL HEART INTERVENTIONS: M D N E W S . C O M /// M D N E W S G R E AT E R K A N S A S ■ 2 018 S T R U C T U R A L H E A R T ❰❰❰❰❰ 2 7

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