Mitral regurgitation is a condition where the mitral valve leaflets do not close tightly. When this happens, blood flows backward from the heart's left ventricle into the left atrium, making the heart work harder to push blood through the body.  There are two types of mitral regurgitation: degenerative and functional.

Degenerative mitral regurgitation, also called primary mitral regurgitation, is caused by damage to the mitral valve leaflets. Functional mitral regurgitation, also called secondary mitral regurgitation, is caused by enlargement of the heart due to heart attack or heart failure. The ventricle becomes enlarged and doesn’t contract like normal, which causes the leaflets of the valve not to meet in the center. 

If left untreated, mitral regurgitation can cause lots of stress on the heart, recurrent episodes of heart failure, severe shortness of breath, swelling of the legs, frequent hospital stays, and ultimately leads to death. Repairing the leak may change the course of the disease and increase a patient’s overall quality of life.

Signs & Symptoms

Many people do not realize that they have mitral regurgitation until they start experiencing symptoms. This can occur gradually over time and may include:

• Fatigue
• Shortness of breath
• Cough
• Heart failure
• A feeling of heaviness on the chest
• Swelling in the legs 
• Palpitations

Treatment Options

Mitral valve regurgitation treatment depends on how severe your condition is, if you're experiencing signs and symptoms, and if your condition is getting worse. The goal of treatment is to improve your heart's function while minimizing your signs and symptoms and avoiding future complications.

Medications

Medications can decrease symptoms and reduce secondary or functional mitral regurgitation, but no medications can treat primary or degenerative regurgitation.

Surgery

Surgical repair or replacement of the mitral valve is recommended for patients who are diagnosed with moderate-to-severe or severe mitral regurgitation. Mitral valve repair or replacement usually involves open-heart surgery while on cardiopulmonary bypass. Mitral valve surgery is usually performed through a cut (incision) in the chest. In many cases, we conduct minimally invasive heart surgery, which involves the use of smaller incisions than those used in open-heart surgery.We recommend mitral valve repair, as it preserves your own valve and may preserve heart function

Mitral Valve Repair

Surgeons can repair the valve by reconnecting valve flaps (leaflets), replacing the cords that support the valve, or removing excess valve tissue so that the leaflets can close tightly. Surgeons may often tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring (annuloplasty band).

Mitral Valve Replacement

If your mitral valve can't be repaired, you may need mitral valve replacement. In mitral valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

MITRACLIP® Transcatheter Mitral Valve Repair

Severe, mitral regurgitation is often treated with open-heart valve surgery. However for high-risk patients, open-heart surgery may not be the best treatment option. For these patients, MitraClip is the only approved minimally invasive, non-surgical treatment option. MitraClip is performed through a vessel in the groin using a catheter. LEARN MORE | MITRACLIP® Transcatheter Mitral Valve Repair

Who to contact

If you have been diagnosed as having mitral regurgitation, you should consult with a cardiologist, who can advise you of your options. Fortunately, there are more options for patients with this disease than ever before.

Broward Heart Valve Center
1625 SE 3rd Ave | Suite 300
Fort Lauderdale, FL 33316
Phone: 954-761-2328
Fax: 954-355-4881

Transcatheter Aortic Valve Replacement (TAVR) is a procedure for select patients with severe symptomatic aortic stenosis - a narrowing of the aortic valve opening.

While open-heart aortic valve replacement surgery has been the standard treatment for severe symptomatic aortic stenosis, less invasive approaches are now available for patients who may not be candidates for open surgery. These inoperable or extremely high-risk patients may be unable to undergo traditional surgery because of factors such as age, history of heart disease, frailty or other health issues.

For these patients, transcatheter aortic valve replacement, or TAVR, may be an option. The TAVR procedure allows physicians to replace a diseased aortic valve without open-heart surgery. TAVR enables the placement of a heart valve into the body with a catheter, which allows the valve to be inserted through a small incision into an artery. Typical hospital stay is overnight.

View Video | Transcatheter Aortic Valve Replacement (TAVR)

How it's done

The TAVR valve that will open and close to regulate the flow of blood is made of a bovine (cow) heart valve stitched inside of an expandable stainless steel scaffold, or stent.

The TAVR procedure is mostly performed under local anesthesia, in a hybrid operating room. A cardiothoracic surgeon, an interventional cardiologist and a clinic coordinator work together, utilizing fluoroscopy and echocardiography to guide the valve to the site of the patient's diseased heart valve.

The most exciting aspect of the TAVR procedure is that it provides hope when there were no previous options. The transcatheter (TAVR) valve offers some patients the potential of a longer life with better quality. The TAVR procedure generally is performed in much less time than open-heart surgery. Additionally, open-heart surgery can require a two- to three-month recovery period, compared to the recovery period of only a few days with the transcatheter (TAVR) approach.

Video does not have sound.

TAVR Criteria

All potential candidates will be assessed and educated by our specially trained team, consisting of a cardiothoracic surgeon, an interventional cardiologist and a clinic coordinator. Together they will conduct a comprehensive evaluation to determine whether the TAVR procedure is an appropriate option for the patient.

Broward Health Medical Center provides the most advanced valve replacement surgeries and treatments using a multidisciplinary approach. Our structural heart program regularly handles the most complex cases in the region with excellent outcomes, including the TAVR valve replacement.

Who to contact

If you are a referring physician or patient and would like to more information about the TAVR procedure or the structural heart program at Broward Health Medical Center, please contact us at:

Broward Heart Valve Center
1625 SE 3rd Ave | Suite 300
Fort Lauderdale, FL 33316
Phone: 954-761-2328
Fax: 954-355-4881

Introduction

This booklet is provided to help you and your caregivers decide if a thoracic stent graft is right for you to treat a thoracic aortic aneurysm. Please read the booklet and discuss any questions with your doctor. Only a doctor can determine whether you are a good candidate for the procedure.

Are You a Good Candidate for the Talent™ Thoracic Stent Graft Procedure?

Anyone who is considering the Talent™ Thoracic Stent Graft procedure should:

• Be able to undergo a procedure that lasts one to three hours.
• Be able to attend regularly scheduled doctor’s visits and tests after the procedure, including at least one visit annually for life.
• Be fully informed about the risks and benefits of the Talent™ Thoracic Stent Graft procedure as compared to open surgical repair.
• Patients who have very large aneurysms and/or vessels with many bends or curves may not be good candidates for the stent graft procedure. Discuss with your doctor which treatment is best for you.

How is the Talent Abdominal Stent Graft procedure performed?

The procedure is performed under regional or general anesthesia. Before the procedure, several tests are performed that let your doctor see the aneurysm and the area around it. These tests are usually performed using imaging such as a CT scan. A CT scan is an imaging technique that creates a series of X-rays that are used to form a picture of your aneurysm and adjacent blood vessels. A CT scan does not hurt and you will be awake for this testing. 

To prepare for the stent graft procedure, a small cut is made in your groin to allow access for the stent graft delivery catheter into the femoral artery. Sometimes the doctor will use a conduit (a surgical graft attached to a larger artery in your pelvis) if the artery in your groin is too small to deliver the device. The doctor uses fluoroscopy (video-like X-rays) to see the device move through the blood vessel in your groin. The doctor also uses fluoroscopy to correctly position the device over the aneurysm in your descending thoracic aorta.

When the delivery catheter is properly placed, the Talent™ Thoracic Stent Graft is released slowly from the delivery catheter into the aorta. As the stent graft is released, it expands automatically to its proper size (see Figure 7) so that it fits snugly to the aorta both above and below the aneurysm. 

Depending on the shape and size of your aneurysm, additional stent grafts may be used. This ensures that the stent grafts span the full length of the aneurysm and blood is no longer flowing into the aneurysm. Fluoroscopy is then performed to allow your doctor to see that the stent graft has been placed properly. The procedure typically takes one to three hours to complete.

Patients often leave the hospital within one or two days of the procedure. Patients can usually return to their normal quality of life within a few weeks. 

What are the Risks?

As with any endovascular stent graft, the Talent Abdominal Stent Graft comes with risks. Please discuss all risks with your doctor. Major risks associated with abdominal endovascular stent grafts include, but are not limited to:

Clinically Associated Events

The endovascular stent graft procedure is a surgical procedure; as such, there are possible complications associated with the procedure.

Before deciding if the procedure is right for you, please review the list of possible procedural complications with your doctor:

Device Related Events

Endovascular stent grafting is a new therapy. Therefore, long term safety and effectiveness of the Talent™ Thoracic Stent Graft has not been established. Please discuss with your doctor if this therapy is right for you.

Possible complications of the device may include, but are not limited to the following:

• Leaking of blood around the graftx (“Endoleak”)
• Movement of the graft away from the desired location (“Migration”)
• Additional procedures 

What are the Benefits?

There are a number of benefits that are related to having a thoracic stent graft procedure:

• A lower risk of death compared to open surgery.
• The patient loses less blood during the procedure.
• The patient will spend less time in the intensive care unit after the procedure.
• The patient will have a shorter hospital stay with faster recovery time compared with open surgery

Please discuss the benefits of all treatment options with your doctor so that you can determine which procedure is right for you.

Introduction

You have discussed having a stent graft procedure to treat an abdominal aortic aneurysm (AAA) with your doctor. Your doctor has given you this guide to help you further understand the device and procedure. Only a doctor can determine if the patient is a good candidate for a stent graft procedure.

What is the Talent Abdominal Stent Graft?

The Talent Abdominal Stent Graft is a fabric tube supported by a metal framework. The stent graft is designed to exclude the aneurysm and reinforce the weakened wall of the aorta. The stent graft reduces the pressure on the aneurysm and provides a new pathway for blood flow. This reduces the risk of rupture. The stent graft is placed in the aorta using a device called a delivery system. The delivery system is a long thin tube-like device that contains the compressed stent graft.

How is the Talent Abdominal Stent Graft procedure performed?

This procedure is performed using anesthesia. Prior to the procedure, imaging tests like CT scans are performed. These tests allow the doctor to assess the aneurysm. A small cut is made in both upper thighs to prepare for the stent grafting procedure. Fluoroscopy is used to guide the delivery system to the AAA. The delivery system is a long thin tube like device
used to place the stent graft in the aorta. The delivery system is advanced through the large vessel in the patient's thigh (femoral artery) to reach the abdominal aneurysm.

The stent graft is slowly released from the delivery system into the aorta. As the stent graft is released, it expands to its proper size so that it snugly fits into aorta both above and below the aneurysm. The delivery system is then removed from the body. The stent graft remains inside the aorta permanently. Additional stent grafts may be required to completely exclude the aneurysm. Imaging procedures are often performed to check whether the stent graft is properly placed.

What are the Risks?

As with any endovascular stent graft, the Talent Abdominal Stent Graft comes with risks. Please discuss all risks with your doctor. Major risks associated with abdominal endovascular stent grafts include, but are not limited to:

• Endoleaks: An endoleak is the leaking of blood around the graft into the aneurysm sac. Endoleaks can be detected using CT scans. Most endoleaks do not require treatment. Your doctor can decide if you need any treatment.
• Stent Graft Movement: This is the movement of the stent graft from its original position over time. This can be assessed using imaging techniques like CT scans. Your doctor can decide if you need any treatment.
• Device Related Issues (example: breaking of sutures or metal portion of the stent graft): Device related issues can be detected using imaging techniques such as X- rays. Your doctor can decide if you need any treatment.
• Aneurysm Rupture
• Additional endovascular or surgical procedures may be required

What are the Benefits?

There are a number of benefits to having a Talent Abdominal Stent Graft procedure, some of which are listed below:

• The procedure is minimally invasive
• Procedure can be performed under local anesthesia
• Lower surgical complication rate compared to open surgery
• The patient may lose less blood during the procedure
• The patient may spend less time in the intensive care unit after the procedure
• The patient may have a shorter hospital stay with faster recovery time compared to open surgery

Are you a good candidate?

Based on your anatomy, your doctor can decide if you are a good candidate for this procedure. Anyone who is considering the Talent Abdominal Stent Graft procedure should:

• Be able to undergo a procedure that typically lasts between one to three hours
• Be able to go for regular follow-up visits after the procedure
• Be fully informed about the risks and benefits of the Talent Abdominal Stent Graft procedure.

What can you expect after a stent graft procedure?

Immediately after recovery from the stent grafting procedure, you may be required to lay flat for four to six hours. This will allow the leg wounds to start healing. Some mild
discomfort may be felt at the wounds in the groin. This usually resolves in two days. Side effects may include swelling of the upper thighs, numbness of the legs, nausea, vomiting, leg pain or throbbing, lack of appetite, fever and / or absence of bowel movement for one to three days.