Dr Paul Chiam, interventional cardiologist at Mount Elizabeth Hospital, talks about a minimally invasive approach to treating leaking heart valves.
For patients with heart valve disease, the main treatment option is usually heart valve replacement surgery. In a heart valve replacement surgery, the surgeon removes the damaged or diseased heart valve and replaces it with a prosthetic valve, restoring normal blood flow and function in the heart muscle.
Treating a leaking heart valve
In some patients, however, a gap can appear between the implanted prosthetic heart valve and the patient’s own heart tissue due to a breakdown in the sutures that secure the valve in place. This can lead to a leakage of blood through the side of the implant. If left untreated, this may result in more serious complications like haemolysis (breakdown of red blood cells) or heart failure. Known as a paravalvular leak, this complication occurs in around 1 – 10% of valve replacement patients.
Previous treatment options were limited, often involving a repeat (and higher risk) open heart surgery to repair the paravalvular leak or to replace the prosthetic heart valve entirely.
In recent years, techniques have progressed, and a more advanced procedure known as percutaneous paravalvular leak repair has become more common, offering patients a minimally invasive approach for treating a leaking heart valve.
Percutaneous paravalvular leak repair
Percutaneous paravalvular leak repair surgery is performed via a small puncture in the groin, on a beating heart, without the need to open the chest to access the heart valves.
A small catheter is fed through an artery or vein in the leg to the heart where, with the help of a guidewire and advanced imaging, a ‘plug like device’ is deployed into the paravalvular leak to close the gap. The procedure requires the skill of a trained interventional cardiologist due to its technical complexity.
In a small number of patients, the leak cannot be closed due to problems with the guidewire’s inability to cross the heart valve defect, and in these cases a more invasive approach is needed.
What is recovery like with keyhole surgery?
Compared to open heart surgery, a percutaneous paravalvular leak repair is performed in just a few hours and doesn’t require a re-opening of the chest cavity. Recovery time is significantly shorter for patients undergoing a minimally invasive procedure, and many can be discharged the day after the procedure.
With an increasing number of patients with surgical valve replacements in the Asian region, the number of patients with valve leakage problems is expected to rise. These patients may benefit from the keyhole approach of percutaneous paravalvular leak repair surgery.