Today, physicians at Piedmont’s Marcus Heart Valve Center opened new doors for patients who are traditionally turned away for valve replacement due to severe thickening and stiffening of the mitral valve. By successfully performing a groundbreaking procedure for the first time in the United States and only the fourth of its kind in the world, they have shown replacement can be done in high risk patients.
“There were no other options for me,” said 76-year-old Margaret Komendantov who lives just north of Columbus, Georgia. The wife of a Vietnam veteran and retiree of Suntrust Bank now looks forward to a trip to St. George Island on Florida’s Gulf Coast with her husband, three children, daughter-in-law and four grandsons. She said, “Our vacation last fall was not fun. I wasn’t able to walk from one end of the house to the other. I’m going to enjoy this vacation.”
Months of collaborating with colleagues in Washington, DC, London and Switzerland and pleading their case for compassionate use earned the Piedmont physicians’ approval from Boston Scientific and the FDA to use the Lotus Valve System to replace Komendantov’s calcified and failing mitral valve. Approval was required because the technology is still in clinical trials for replacement of aortic valves, not mitral.
“Thousands of patients suffer from mitral valve regurgitation due to severe stenosis,” said Christopher Meduri, M.D., interventional cardiologist who performed the procedure alongside a team of experts at Piedmont Atlanta Hospital. “When the valve fails, oxygen-rich blood can’t get out of the heart chamber to sustain rest of the body.”
Heart valve experts know well how different each person’s anatomy can be. “No valve surgery is ever ‘routine’ for us,” Dr. Meduri explained. “Margaret had already been through several complicated heart procedures, made more complex by the unique anatomy of her heart. Only one solution existed based on my findings, and it required the ability to perfectly position the replacement valve.”
Through his research, Dr. Meduri found Vinayak (Vinnie) Bapat, M.D., the one physician in the world who has previously performed the procedure on patients like Komendantov. Dr. Bapat, who is on staff at London Bridge Hospital in England and traveled to Atlanta to consult during the case, has successfully performed the procedure three times using the Lotus Valve System which allows for testing. This allows physicians to make sure it is working, reposition it if it is not and pull it back if the risk becomes too extreme.
In addition to securing the right technology and the perfect consultant, the Piedmont team enlisted imaging experts in Switzerland to help create a 3D model of Komendantov’s heart. With the image, they developed a preview of the way the procedure would have to play out, working the catheter through her hardened heart tissue.
They even used her calcified valve as a landing zone for accurate positioning. After review of those images during a meeting in Washington D.C., collaborators believed it could work. They were right.
At the end of the catheter wire was the replacement valve inside a stent (a mesh tube). When expanded, the stent pushed everything aside including the old calcified valve and locked it in place, allowing Dr. Meduri to position and secure the replacement valve.
“Without treatment, there was a 50 percent chance Margaret wouldn’t have lived an additional two years,” said Dr. Meduri. “But because we went to such lengths to find a solution that worked for her, Margaret’s prognosis is much better and her quality of life will be greatly improved.”
For more information about Piedmont’s Marcus Heart Valve Center, visit the Marcus Heart Valve Center page at http://www.piedmont.org/marcus-heart-valve-center/marcus-heart-valve-center-home.