MDNews - Minnesota

COVER FEATURE Minneapolis Heart Institute Valve Center Multidisciplinary Approach to Complex Treatments in Valve Disease AT ABBOTT NORTHWESTERN HOSPITAL V ALVE ABNORMALITIES THAT cause aortic stenosis and mitral insufficiency predominantly affect our growing elderly population. In the United States, an estimated 140,000 patients suffer severe aortic stenosis annually. When aged in our 80s, 5% to 7% of us will develop severe stenosis. By the time we reach our 90s, 10% to 12% of us will become afflicted with this disease. Mitral insuf- ficiency is even more common. Currently in the United States, con- ventional surgical valve repair and replacement are the only treatment options. Elderly patients with comorbidi- ties or excessive frailty are at greater risk for these invasive treatments. Medications have minimal effect on symptoms, and unlike surgery, they don't change the natural history of the disease. Without invasive treatment options, these patients face a painful decline in quality of life, reduced longevity and heart failure. At the Minneapolis Heart Institute (MHI) Va lve Center at Abbot t Northwestern Hospital, a multidisci- plinary, subspecialty team — led by Director Wes Pedersen, M.D., and Co-Directors Vib Kshettry, M.D., and Kevin Harris, M.D. — has been pioneer- ing percutaneous treatment research to address both aortic stenosis and mitral insufficiency. These physicians represent the subspecialties of interven- tional cardiology, cardiac surgery and echocardiography, respectively. In 2008, Dr. Pedersen performed the world's first in-man percutaneous implant of the iCoapsys mitral valve device to repair functional mitral insufficiency. "Between 30% and, possibly, 50% of people in the United States are not receiv- ing treatment for aortic stenosis because they are either frail or have comorbidities that place them in an excessively high-risk group for surgery," explains Dr. Pedersen. "Fewer than half of the 150,000–250,000 patients with significant mitral insuf- ficiency are undergoing surgical repair or replacement. The large, remaining group is comprised of patients who are not traditional valve surgery candidates for similar reasons: comorbidities, frailty or end-stage left ventricular dysfunction. We need a less invasive way to treat these patients. Percutaneous or transcatheter options were developed specifically for those patients in whom surgery is not an option. In Europe, 14% of the aortic valve replacements being carried out are transcatheter. That number is expected to rise to 20% next year and possibly to 40% in the next three to four years." The MHI Valve Center is one of 27 centers participating in the PARTNER A multidiscplinary team of providers meets weekly to discuss complex valve cases.

• Cover