A clip of a bedridden 86-year-old man with his daughter by his side plays on the screen. She tells the audience he had a heart attack in 2016, and over the following years, he lost his ability to walk, sit, concentrate and even go to the restroom on his own. He went through a minimally invasive cardiac surgery using the ‘MitraClip’, a 15 mm by 6 mm clip that is used to plug a leakage in the mitral valve (which lies between the left atrium and the left ventricle of the heart).
The next clip shows the frail looking man being able to get up without assistance after a month of the surgery. Subsequent photos show him watching the television, walking, and smiling, six months later. “Now he has survived COVID-19, he does his own gardening, and he is fighting with his children to drive his own car…” says Dr Sai Satish, Senior Interventional Cardiologist, Apollo Hospitals, Chennai.
On Tuesday, in a hybrid virtual and live press interaction, Apollo Hospitals Chennai said that it had become the first in Asia to do four cardiac procedures using the MitraClip, surpassing Japan, where three such procedures have been performed in a day. Dr Sai Satish, who performed the procedures, said, “26 million cases of heart failure are diagnosed in the world. It is estimated to be 37 million including undiagnosed cases. The number one reason for hospitalisation is heart failure, and half of the patients will get re-hospitalised for heart failure within six months.”
He explained that such patients have a miserable quality of life and have very high mortality of up to 57% in five years; and mitral regurgitation can be a significant component in such cases, worsening outcomes in heart failure patients. This, he added, is now addressable through MitraClip, because it not only fixes the issue but also returns the quality of life for patients.
Mitral Valve Disease is a condition where the valve does not close properly, thus causing blood to leak back into the left atrium of the heart. “A majority of the blood goes backward then, into the lungs, and the person feels like they are choking. It also means that there isn’t enough blood flowing into other parts of the body. This significantly worsens the quality of life,” Dr Satish said, estimating that India has about 4-5 million cases of mitral valve disease.
“The minimally invasive method used in MitraClip therapy allows repair of a leaking mitral valve without open heart surgery, and is a lifesaver for patients at high surgical risk. All four patients, the oldest of whom was 87 years old, went home walking within 3 days and are currently doing well,” Apollo said in a media release.
While Apollo has been performing MitraClip procedures for three years and is accredited to carry them out, the case for performing four such surgeries in a day was a departure from the norm. “While the original plan was to only operate on two patients that day, the other two decompensated rapidly and needed immediate attention as well,” Dr Satish said.
On being asked if it was metal scan or detection safe, Dr Satish answered in affirmative. “The clip is made to be in your body permanently. It is also removable and repositionable.”
A recent trial, shared by the doctor, has found that using the MitraClip with guideline-directed medical therapy (GDMT) performs better than the latter in reducing hospitalisation for heart failure patients as well as mortality in symptomatic heart failure patients with grade 3-4+ mitral regurgitation.
Further, Apollo Hospitals is developing an initiative by the name of Echo Connect Project that will scale up the program to detect leaking mitral valves at a nationwide level.