The Catharina Hospital has a European first: the first placement of a new mitral valve through the groin. It creates patients who now have the prospect of a future, while they were previously out of treatment.
The Heart and Vascular Center has taken another important step in the treatment of heart valve problems. For the first time in Europe, a new, smaller mitral valve (one of the four heart valves) has been placed via a catheter in a vulnerable patient for whom classic open-heart surgery was not an option. The procedure is part of an international study.
The mitral valve is located between the left atrium and the left ventricle of the heart. If that valve leaks, blood flows back instead of forward. This leads to complaints such as fatigue, shortness of breath, and fluid retention. For some patients, surgery is too taxing. Until recently, there were no options for them that fit their needs.
"With this technique, we can place a new valve through the groin. That is less invasive than open-heart surgery, and offers new hope for vulnerable patients," says Pim Tonino , interventional cardiologist and professor at TU/e, where he focuses on so-called minimally invasive - which means: less invasive - heart procedures with catheters.
The new valve is a technical innovation: smaller in size, allowing it to be placed via a thin catheter. The valve is inserted into the heart and secured there. The Catharina Hospital is the first center in Europe to use this valve. During the very first procedure in July, the team worked together with an American colleague who had come to Eindhoven to assist with the procedure.
Increasing treatment options
The first patient had previously been told that there were no more treatment options for her. In the Catharina Hospital, she was the first to get this new valve. "That was a real milestone," says cardiologist Sjoerd Bouwmeester. "
I see fit octogenarians of whom I know: if we offer them treatment, they will have ten more great years.
Sjoerd Bouwmeester, cardiologist at the Catharina Ziekenhuis Eindhoven
"We already have a lot of experience at the Catharina in repairing leaking mitral valves with clips. We place a kind of staple on the valve through the groin, so that it closes better and less blood flows back. But if such a clip does not stay in place or is not technically possible, we had no alternatives to offer our patients. Now we can replace the entire valve in certain cases. This significantly increases our treatment options. I see fit octogenarians of whom I know: if we offer them treatment, they will have ten more great years.
Working closely together
The heart team works closely together during these procedures. Tonino and fellow interventional cardiologist Koen Teeuwen insert the valve through the catheter. Bouwmeester is responsible for imaging and guides the team like the eyes of the operating room.
The team also includes heart surgeon Ka Yan Lam. Bouwmeester: "That collaboration is crucial. Thanks to our years of experience with clip treatments, we are perfectly attuned to each other. This makes it possible to introduce new techniques safely and effectively."
The mitral valves that are now being placed in the Catharina Hospital are part of an international study funded by the manufacturer. For other innovations, such as the replacement of the tricuspid valve (another heart valve) via a catheter, the hospital uses its own innovation budget.
"I think it's admirable that the Catharina Hospital is willing to invest in this," says Bouwmeester. "Don't wait until these procedures are (insured) standard care, but look at how we can help patients, right here and now. That's what makes it so special for me to work here. We dare to innovate."
Increasingly complex anatomy
Developments are moving fast. While the replacement of the aortic valve via catheter (the so-called TAVI) is now common, the technique for mitral and tricuspid valves is still in its infancy. The anatomy is more complex, and the valves are more difficult to secure.
"But that is precisely why we want to gain experience," says Teeuwen. "It lets us offer more patients appropriate treatment, even if they previously had no options."
In short, these steps are just the beginning. It is expected that more types of catheter valves will become available in the coming years, in more sizes, and with even less burden on the patient. The Catharina Hospital is one of the few centers in the Netherlands that participates in this type of study.
Bouwmeester: "The best thing is that you can help patients who otherwise have nowhere to go. When you see those people recovering, you know why you do this work."
The number of patients reporting to the Heart and Vascular Center of the Catharina Hospital is growing rapidly. And that is good news in a way: more and more people are eligible for effective treatment that is less demanding. "Catheter treatments are developing at lightning speed," says Bouwmeester. "The possibilities are expanding, so that we can look more and more specifically: what is the best approach for this patient?"
Tonino adds and concludes: "We see it as our responsibility to make this innovative care available, also for people outside our region. Everyone should be able to benefit from this progress."
