Queen’s adopts new procedure for sick tickers

Earlier this year Juliana Caneda had trouble breathing, became weak when walking and felt her heart racing.

She was diagnosed with mitral regurgitation, a potentially debilitating and life-threatening disease in which a leaky valve causes a backward flow of blood in the heart.

With multiple conditions, including thyroid cancer and a previous triple bypass, she was too frail to endure another open-heart surgery. So doctors opted for a less invasive procedure to stop the leaky valve through the groin.

Caneda, 86, was among the first patients at the Queen’s Medical Center to receive the state’s only minimally invasive treatment for patients suffering from mitral regurgitation, a condition that can increase the risk of irregular heartbeats, stroke, and heart failure leading to death.

The procedure uses the MitraClip, an FDA-approved device for patients with severe degenerative mitral regurgitation who would be at high risk if they underwent traditional open-heart surgery. Queen’s began offering the procedure last month.

"I just felt good the moment I woke up. I just felt like a new person," said Caneda, who had the two- to three-hour surgery Aug. 5. "I was ready to get up and dance. I needed to have that done, otherwise I’d probably be in a wheelchair not being able to do a lot of things."

A team of physicians make a single puncture in the groin to deliver the device to the heart through the femoral vein, a blood vessel in the leg. A clip is then attached to a snakelike contraption allowing doctors to steer and position the clip in place while the heart is still beating. Once implanted, it allows the heart to pump blood more efficiently, thereby relieving symptoms and improving the patient’s quality of life. Patients typically experience faster recovery times and shorter hospital stays.

"Before MitraClip there really were no alternatives for these high-risk patients," said Christian Spies, an interventional cardiologist and director of Queen’s cardiac invasive services. "Patients would either have to accept the risk of invasive, open-heart surgery or be left with the progression of a weakened heart and congestive heart failure."

Symptoms often include being chronically tired and easily winded, and for some people, "even doing the dishes could cause shortness of breath," he said.

Spies didn’t immediately know the cost of the procedure since the Medicare health insurance program for seniors has not yet put a price on it, but he said it will likely be less than the cost of open-heart surgery at between $60,000 and $90,000.

"The recovery time is exclusively related to anesthesia," Spies said. "If you do surgical repair, it is obviously open-heart surgery where the heart is put to rest for one to two hours. It’s at least five to six days in the hospital and recovery for several more weeks. Our patients have been up and walking within two to four hours after the procedure. We see an immediate and dramatic improvement in them. Their heart is in better shape, they have more endurance, they can engage more in activities of daily living and they feel better."

Mitral regurgitation is the most common heart valve problem in the U.S. An estimated 20,000 Hawaii residents have the condition and are at risk of developing a worse form of the illness, Spies said.

The condition affects more than 4 million Americans — nearly 1 in 10 people 75 and older, though only about 70 hospitals nationwide offer the procedure. Queen’s expects to treat between 30 and 50 patients a year.

Last year, Queen’s became the first hospital in Hawaii to offer heart valve replacements via catheter through the groin for heart disease patients previously deemed inoperable.

The new cardiac procedure for aortic stenosis, a severe narrowing of a heart valve, made it possible for patients too ill to tolerate the standard valve replacement via open-heart surgery to receive treatment.

On Aug. 4, Rose Nip, 83, was the first patient to have the mitral regurgitation procedure done at Queen’s.

"I wasn’t walking that good. I would get tired and out of breath even in the evening when going to bed," Nip said. "Now I can walk a little bit faster. My quality of life has been improved. I feel so much better. Open-heart surgery wasn’t my choice."