New treatment option available for some patients living with leaky heart valve condition

Members of the QEII mitral valve clip implant team between cases at the Halifax Infirmary Cardiac Catheterization Laboratory in November 2021. Pictured left to right: Marcy Kennedy RN; Dr. Doug Hayami, cardiologist; Shirley Garnett anesthesia technician; Michelle Taylor, RN; Dr. Edgar Chedrawy, division head of Cardiac Surgery; Dr. Victor Neira, anesthetist; Lynn MacKendrick RN; Dr. Osama Elkhateeb, cardiologist; Dominique Zwicker MRT, and Shashidhar Bangera, RN

By Krista Wood

John Dillman is thankful for many things. Topping this list are his loving and supportive family, the exceptional health care team that has rallied around them since his near-fatal heart attack and more recently, becoming the first patient to receive a life-changing heart valve procedure at the QEII Health Sciences Centre.

After suffering a massive heart attack in 2016 that left him hospitalized for a month, heart specialists said it likely wasn’t his first and that it, combined with other undetected heart attacks, had caused severe damage.

“I had lost about 65 per cent of the muscle in my heart and testing revealed a leaky heart valve (mitral valve) that would keep getting worse,” he said.

“I was easily winded, would often have to stop to rest and hold on to things for support and there has always been this concern about what could happen,” he said.

The husband, father of six and grandfather of 13 had to step back from managing his family’s Elderbank dairy farm and purebred cattle business and curtail the duties that routinely kept him in the barn more than 12-hour days.

Over the years his team have helped him manage this condition with medication and close follow-ups. This included his family physicians Dr. David Sheehy and Dr. Katelyn Barnes. His team made it clear that open-heart surgery to correct the problem would be too risky. The potential of being added to the heart transplant list, as his condition worsened, even factored into the discussions.

“My team at the Advanced Heart Failure/Heart Transplant Clinic, including my nurses were a Godsend. It was so good to know that I could call my registered nurse, Kate Storm and there would be someone on the other end of the phone to help,” he said.

Leaky heart valves are among the more common heart problems affecting Nova Scotians with about one of every 10 people over 70 living with a significant form of the condition. Left untreated it can lead to symptoms of heart failure and even death.

Officially called mitral regurgitation or mitral insufficiency/incompetence, the condition means the heart’s mitral valve (one of four valves in the heart) doesn’t close tightly as it pumps blood. Instead, a flap remains partially open, allowing some blood to flow backwards. This strains the heart, making it work harder.

Patients like Dillman can face serious health issues and discomfort ranging from fatigue, chest pain, swollen feet or ankles and shortness of breath, to heart attacks or heart failure, where the heart can’t move blood well enough to meet all the body’s needs. In mild cases, with minimal blood leakage and no symptoms, no treatment may be required. However, patients with more significant leakages often require surgery to replace or repair the faulty valve.

Unfortunately, open-heart surgery can be too risky for some patients due to their age or other health factors. Instead, their condition is most often managed medically.

These patients are prescribed medications, closely followed by the heart team and often live with reduced quality of life and face repeated hospitalizations to respond to heart failure or heart attacks.

While it seemed there were few options for him, Dillman’s team mentioned a less invasive procedure being offered in other parts of Canada. The procedure offered hope for increased comfort and improved quality of life for some patients with severe mitral regurgitation. Rather than correcting valve issues with open heart surgery, mitral valve clip procedures allow for a small metal clip (Mitra Clip) to be inserted through a vein in the patient’s leg and permanently attached to the opening of the mitral valve, helping it function as it should.

While Dillman was willing to travel to Toronto or Montreal for the procedure, he asked why it wasn’t available at the QEII, where they have highly specialized teams, a heart centre and a teaching and research focus.

A QEII-based program was being eyed and Dillman credits his cardiologist, Dr. Osama Elkhateeb and the entire heart health team, for their efforts to bring this treatment option to Nova Scotia.

He was only too happy to be their mitral valve clip first patient when the Cardiac Catherization Laboratory team launched their new mitral valve clip program in June 2021.

“I am over the moon with my outcomes,” he said. “I am very impressed with my team and grateful they took this program on. The recovery time was quick, and I found quite a difference right away.”

Several other patients have since received the procedure.

The program was made possible by a team of cardiologists, cardiac surgeons, anesthetists, nurses, anesthesia technicians, diagnostic imaging staff and team members from the Cardiac Catherization Lab and Coronary Care Unit.

Dr. Osama Elkhateeb, Dr. Edgar Chedrawy, division head of Cardiac Surgery, QEII Health Sciences Centre, cardiologist Dr. Doug Hayami and anesthetist, Dr. Paula Kolysher, spearheaded the team and earlier this year, physicians and staff underwent significant training to prepare to offer the complex and time-consuming procedures.

Recently published clinical trials highlight the effectiveness of mitral clips.

“Compared to medical treatment alone, patients who received the mitral clip demonstrated significant improvement in their quality of life through 24 months,” said Dr. Elkhateeb. “There was also a reduction in deaths and heart failure hospitalizations, which represents a substantial reduction in costs to the health system.”

The intricate procedures are performed at other tertiary care facilities across the country with a specialist from the company that supplies the clips on site to oversee and support each case.

Not all patients are eligible for this procedure and the team works closely to identify patients who could benefit from the service.

“We expect to provide 10 patients the procedure by year’s end,” said Anthony Wiseman, who is the health services manager responsible for the QEII’s Cardiac Catherization Laboratory. “Our long-term goal is to offer up to 15 mitral implants a year once the program is well established.”