Posted on July 14th, 2010 under Mitral Valve Repair.
Recently, I was extremely lucky to observe Dr. Saibal Kar and his team perform its 103rd MitraClip procedure on a patient with severe mitral regurgitation at Cedars-Sinai Hospital in Los Angeles, California.
Dr. Saibal Kar And Me In The Cath Lab At Cedars-Sinai
While I expected to watch the procedure from a gallery – much like an episode of Grey’s Anatomy – I quickly found myself inside the cardiac catheter lab wearing scrubs and a lead suit used to protect me against x-ray exposure from fluoroscopy.
For the next three hours, I had front-row access to Dr. Saibal Kar’s team as they cared for the patient and deployed the new MitraClip device. Yes… This was much, much, much better than an episode of Grey’s Anatomy.
Although the MitraClip has yet to receive FDA approval in the United States, Dr. Kar has been using the device to treat mitral valve regurgitation without causing any physical trauma to the patient’s sternum or ribs. As previously discussed, the results of the MitraClip clinical trials have been encouraging.
A few minutes before the procedure began, I was very surprised to see a familiar face enter the cardiac catheterization lab. Doctor Alfredo Trento, the Chief of Cardiothoracic Surgery at Cedars-Sinai Hospital, quietly assumed a position to left of Dr. Kar.
Dr. Kar (Cardiologist) and Dr. Trento (Cardiac Surgeon)
Work Side-By-Side During A MitraClip Procedure
“This has got to be somewhat unique,” I thought to myself, “Given the distinct nature of their specialties and some of the skepticism surrounding the MitraClip from the surgeon community, I can not imagine this is common.” (I would later learn that, so far, only a handful of cardiac surgeons have taken a serious clinical interest in this non-invasive procedure used to treat mitral valve regurgitation.)
Regardless of their specialties, these cardiac gurus – Dr. Saibal Kar and Dr. Alfredo Trento – worked seamlessly together.
Dr. Alfredo Trento, Cardiac Surgeon,
Operating The MitraClip Delivery System
I’ll be honest… As an observer, I was relatively clueless to most of the conversations in the catheter lab. There was so much medical data chatter going back and forth amongst the medical team – comprised of cardiologists, surgeons, anesthesiologist and nurses – that my ears went somewhat numb.
Thankfully, Dr. Kar’s physician assistant, Asma Hussaini, and other visiting cardiologists (including Steve Goldberg, from Kirkland, Washington), helped me understand the key steps of this transformational procedure in laymen’s terms.
For me, there were several highlights of this MitraClip experience:
- While the actual MitraClip is tiny, the delivery system by which the MitraClip is passed through the transfemoral vein is quite elaborate and larger than expected.
Asma Hussaini Holding The Unopened MitraClip Delivery System
- The catheter size of the MitraClip guide is 8.6 millimeters in diameter and it is placed via needle puncture into the femoral vein. By comparison, the surgical scar that runs down my sternum is about nine inches, or 228.6 millimeters.
The Patient’s Catheter Insertion Site (Groin)
- A portion of the MitraClip procedure is spent navigating the catheter through the vein to find an optimal area to cross the septum which divides the right and left side of the heart. This assures that the MitraClip will be easily placed in proper position to grasp the defective mitral valve leaflets. As Dr. Kar explained, “This is one of the most critical steps in the procedure.”
Dr. Kar, Dr. Trento & Dr. Buch Insert The MitraClip Into The Catheter
- A small hole must be made in the septum which divides the right and left atrium of the heart to provide the MitraClip access to the diseased mitral valve. No sutures are needed to close this hole as our hearts heal relatively quickly, according to Dr. Goldberg.
- The clip arms are used to bring the mitral leaflets together creating a double orifice valve. The MitraClip can open-and-close multiple times to ensure the best result.
The First MitraClip Is Locked Into Place
- Once the MitraClip is positioned and closed, valve function can be evaluated in real time using two dimensional (2D) and three dimensional (3D) echocardiography. If the mitral regurgitation is eliminated or reduced to “mild” status, the MitraClip is then “locked” into place and separated from the delivery catheters. The MitraClip will then move freely with the mitral leaflets.
Dr. Kar and Dr. Trento Evaluate Mitral Regurgitation
After Primary MitraClip Closure
- According to Dr. Saibal Kar, about 30-50% of patients now receive two (2) MitraClips to minimize regurgitation. As you may recall, Kato Pomer, the 92-year old woman I recently interviewed, received two MitraClips during her life-saving operation.
To Minimize Regurgitation, A 2nd MitraClip Is Positioned
- The MitraClip procedure is covered by some insurance programs. In fact, I heard that a new Medicare code is about to be issued for this non-invasive procedure.
- The MitraClip is made from cobalt chromium. A polyester fabric coats the clip to promote healing.
- The MitraClip and delivery system are manufactured in the company’s headquarters in Menlo Park, California.
Dr. Kar’s Team – Noorbibi Gheewalla, CVT (Monitor), Asma Hussaini, PA-C (Physician Assistant), Saibal Kar, M.D., Bret Wertman, M.D. (Interventional Fellow), Omar Dura, M.D. (Anesthesiologist), Mamta Buch, M.D. (Fellow)
Needless to say, this was an extraordinary experience. I want to thank all of the medical staff at Cedars-Sinai Hospital in Los Angeles, California – especially Dr. Saibal Kar and Dr. Alfredo Trento.
Most importantly, I just learned that the patient is at home doing very well after the procedure.
Keep on tickin!