Saturday, 7 January 2012

Hanging up my Gloves? Not Quite Yet,


MitraClip: Encouraging results in nonsurgical patients | theheart.org

I accept that a device that may supplant a highly morbid and expensive open cardiac surgical procedure deserves attention. However I really cannot get excited or as a surgeon, worried about this particular device. Reading this latest report does not change that stance. I am a mitral valve surgeon and I think I understand mitral regurgitation. In my practice, patients are usually too sick for open mitral surgery because of severe often terminal heart failure. This is usually associated with rapidly declining renal function, a falling sodium and hypotension. The MR is often a manifestation of a failing left ventricle. I just cannot see how decreasing the grade of MR by a small amount would change anything. This was not a randomised study and confounding factors MUST have influenced patient selection.
The problem with mitral regurgitation is that, unlike aortic stenosis (treated by the catheter mounted TAVI device), it has several different aetiologies. Some of these relate to the valve itself, some to the ventricle below and some to the atrium above. Many randomised studies will therefore be required and not one.
Apart from all the above, transseptal perforation is not without its problems and the device is hellishly expensive.