Cardiologists at the Mainz University Medical Center introduce new procedure to treat cardiac valve disorders

First patients already successfully treated using mitral valve clips


At the Department of Internal Medicine II of the Mainz University Medical Center, patients with mitral valve insufficiency can now be treated using a new minimally invasive procedure. The Mainz cardiologists use a technique called percutaneous (endovascular) mitral valve repair. Existing mitral valve leakage can be reduced or even eliminated by a minimally invasive catheter-based clip implantation procedure. This procedure means that it is no longer necessary to open the patient's thorax and put them on a heart-lung machine, the standard process to date fraught with risk. The new procedure is currently being performed in 21 centers throughout Germany. Since it was first performed in Mainz at the beginning of June 2010, six patients have already been successfully treated in this manner.

Mitral valve insufficiency is the most common form of valvular heart disease in Europe. Several million people worldwide are affected by the disorder. The disease is characterized by defective closure of the heart valve, which results in pulmonary blood congestion and thus shortness of breath. If the disease is left untreated for a long period of time, chronic volume overload of the heart may develop which can result in cardiac insufficiency and heart failure.

Previously, various surgical procedures have been the methods of choice for treating defective closure of the mitral valve. However, these necessitate opening the chest and the use of a heart-lung machine. The new procedure only requires a small access to be created in the inguinal vein and leads to a favorable improvement in symptoms, such as fatigue and shortness of breath. In the so-called percutaneous (endovascular) mitral valve repair technique, also known as mitral valve clipping, both mitral valve cusps are modified, thus improving their ability to close or eliminate the defect. The procedure is performed under general anesthesia. The use of a heart-lung machine is no longer necessary. In addition, three-dimensional echocardiography is used throughout to enable accurate positioning of the clip, while x-ray follow-ups may also be necessary. This minimally invasive procedure has a lower risk for patients while simultaneously providing for faster recovery and improved quality of life. However, surgical treatment is still considered the norm because long-term results of the new procedure are not yet available although certain factors, such advanced age or severe comorbidities, mean that surgical intervention is often not possible. Such patients may particularly benefit from the new catheter-based procedure.

This procedure was approved for use in Europe in March 2009 and has since been largely performed in Germany. There are already some 1,700 patients around the world who have been successfully treated using this technique. About 550 of these patients have been treated in the 21 German centers.

"We in Mainz are very proud to be one of the few centers in Germany able to offer such a minimally invasive alternative treatment method," said Professor Thomas Münzel. "It is already becoming apparent that this procedure can improve a patient's quality of life and can be used in patients with severe mitral valve insufficiency, who cannot currently be operated on," added PD Dr. Ascan Warnholtz, who is responsible for this project. "Optimal team coordination between the physicians at the catheter table, the operators of the ultrasound machine (echocardiography machine), the assistants in the cardiac catheter laboratory, and the anesthetists is another important factor determining success," emphasized Professor Christian Werner, Director of the Department of Anesthesiology.