Mitral Valve Program
Providing the best care for patients with heart valve disease requires the close collaboration of different types of heart specialists. MaineHealth brings together interventional cardiologists and cardiothoracic surgeons to offer expert, comprehensive care. We have a proven track record of performing successful mitral valve repairs in patients with early-stage disease.
What is mitral valve disease?
There are several types of mitral valve disease. In patients with mitral valve regurgitation, the flaps (leaflets) of the mitral valve do not close tightly, causing blood to leak backward into the left atrium. This commonly occurs due to valve leaflets bulging back — a condition called mitral valve prolapse. In patients with mitral valve stenosis, the leaflets become thick or stiff, sometimes fusing together. This results in a narrowed valve opening and reduced blood flow through the valve. The heart often needs to work harder to pump which can cause it to enlarge or weaken. While some patients have no symptoms, others experience shortness of breath, chest pain, leg swelling or dizziness.
In recent years, clinical trials have indicated that early treatment of mitral valve regurgitation by specialized heart teams, before the heart weakens, can help improve patient outcomes. In addition, technology advancements have led to the development of minimally-invasive surgical techniques and catheter-based intervention to treat mitral valve disease. Maine Medical Center, one of the largest heart valve centers in the northeast, has been a leader in the development of these techniques.
A Mitral Center of ExcellenceMaine Medical Center is a Mitral Center of Excellence. We provide in-depth evaluation of mitral valve disorders including comprehensive imaging assessment of the severity of the valve narrowing or leak. Our multidisciplinary team of specialists in cardiology, interventional cardiology, cardiothoracic surgery and specialized imaging focuses on the care of patients with mitral valve disease. The team combines experience and expertise to find the right treatment for individual patients to provide the best possible outcome.
Collaboration and Innovation
Maine Medical Center (MMC) was the first hospital in Northern New England to participate in a national clinical trial to test a minimally-invasive approach for treating mitral valve regurgitation. During this procedure, a special metal clip is delivered via catheter and attached to the flaps (leaflets) of the mitral valve. The doctor adjusts the clip placement to achieve optimal blood flow and pressures through the valve, then releases the clip and withdraws the catheter. The clip holds the valve leaflets in place, limiting leakage. This clip device is called MitraClip™ and is now an approved device that is an option for some patients with mitral valve regurgitation.
Mitral valve surgery as we know it today became possible at MMC when the hospital acquired its first heart-lung machine over 60 years ago. Since then, over 50,000 open-heart operations have been performed at MMC. In the 1980s, MMC surgeons adopted mitral valve repair techniques that have since evolved into the highly-complex and successful procedures of today. Our surgeons and surgical teams are well trained and experienced, resulting in mitral valve repairs that are competent and durable, improving the lives of over 150 patients annually.
Complex mitral valve repair requires medical and surgical management. Decisions and recommendations are based on evidence and sound judgment from an experienced team. The procedures are complex and involve nurses, advanced practice providers, echocardiographers, interventional cardiologists, specialized cardiac surgeons, cardiac anesthesiologists and other highly trained team members.
Patients who are candidates for mitral valve repair are carefully evaluated to determine which approach is appropriate for them. A dedicated valve coordinator guides patients through the evaluation process. Members of the care team are with patients every step of the way following a prescribed pathway with expectations that are understood and explained clearly.
We provide patients with advanced valve disease a comprehensive assessment of valve function before beginning appropriate treatment. Cardiologists and cardiac surgeons who specialize in valvular heart disease evaluate each patient and make a joint decision on the best treatment approach. Treatment for mitral valve disease depends on the severity and cause of your condition.
Doctors may recommend:
- New medications or adjusting existing medication
- Surgery to repair or replace the valve
- A catheter-based procedure, such as MitraClip
Several surgical procedures exist to repair or replace mitral valves, including open-heart surgery or minimally invasive heart surgery. During the MitraClip procedure, the heart is accessed through a vein in the patient’s leg in the groin area. A metal clip is delivered by a catheter and attached to the leaflets of the mitral valve to decrease the leakiness of the valve. The doctors adjust the clip placement to achieve optimal blood flow and pressure through the valve. The clip holds the valve leaflets in place, limiting leakage. Our providers may also refer patients to other heart specialists to improve the overall heart function, such as:
- Heart failure specialists - to help decrease fluid weight
- Electrophysiologists - to help regulate heart rhythm
This can improve the function of the valve.
Maine Medical Center (MMC) participated in one of the earliest trials for this indication called REALISM. In March of 2019, the FDA also approved MitraClip for the treatment of mitral regurgitation (MR) from heart failure. Secondary MR, also known as functional MR, is the most common form of mitral regurgitation and has a poor prognosis. Maine Medical Center was the only center in Maine to participate in the multi-centered COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation). FDA approval was largely based on the positive results of this landmark multi-centered trial, which showed improved mortality, heart failure and quality of life.
“We have known for a long time that mitral regurgitation, or leakiness of the mitral valve, is associated with adverse outcomes. In the past, patients who were at increased risk for traditional open-heart surgery may have had limited options for repair. The MitraClip procedure offers these patients a minimally-invasive option that can significantly improve their symptoms.” - Paul F. Frey, MD
“Cardiac surgeons at Maine Medical Center have been on the innovative forefront of mitral valve surgery for over forty years. They implanted the latest iterations of mechanical and biologic valves as they became available and were early adopters of preserving the sub-valvular apparatus in mitral valve replacements, improving outcomes. They acquired the skills to do mitral valve repair techniques from the early experience of straightforward repairs done in the 1980’s to the more complex repairs done today.
One of our mitral valve surgeons, Dr. Reed Quinn has been an innovator in chordal repair and design of the chord-x repair suture system, which has greatly simplified mitral valve repairs. MMC cardiac surgeons have recently become part of the Cardiothoracic Surgical Trials Network, a NIH-funded network of cardiac surgical centers that has conducted and published clinical trials that have guided current mitral valve surgery techniques.” - Robert S Kramer, MD, FACS, Director, Cardiac Surgical Research
Treatment of heart valve disease depends on how severe the condition is and whether symptoms are present. Your doctor may recommend:
- Healthy lifestyle changes
- Medicine to treat the symptoms
- Regular appointments to monitor the condition
Preparing for Surgery
Prior to any surgery, patients will be asked to undergo a number of tests to help determine which surgery or procedure is the best option. These tests typically include a coronary angiography to evaluate the heart arteries, a Transesophageal Echocardiogram (TEE) to better understand the mechanism of the problem and a chest CT. Our care team will discuss these tests with you, recommend which surgery or procedure we feel is the most appropriate option, and answer any questions you or your family may have.
Recovery and Follow-up
After surgery, most patients stay one to two days in the intensive care unit and two to four days on the cardiac post-operative floor. After a catheter based procedure, most patients do not need to go to the intensive care unit. After a few hours in recovery, patient go to a cardiac floor for 1-2 days until discharge.
A discharge coordinator will help arrange any post discharge services that may be needed such as:
- Physical therapy
- Occupational therapy
- Nursing care
Our care team will provide clear instructions prior to the discharge home or to rehabilitation as well as a follow-up appointment with your surgeon and cardiologist. Recovery is unique to each patient.