Clinical Advances Allow Patients to Avoid Open-Heart Surgery

Minimally Invasive Tricuspid and Mitral Valve Procedures Shorten Patient Recovery Time

By Melinda Krigel

UC San Francisco interventional cardiologists and interventional echocardiographers recently performed two novel minimally invasive cardiac procedures for the first time in the health system.

Sammy Elmariah, MD, MPH, UCSF chief of Interventional Cardiology, led a team including Richard Cheng, MD, Atif Qasim, MD, and Neal Shah, MD, who performed UCSF’s first tricuspid valve replacement procedure using the Edwards Lifesciences EVOQUE system on a patient with tricuspid regurgitation.

Tricuspid regurgitation (TR) occurs when the tricuspid valve in the heart does not close completely, usually because the valve has dilated or stretched, and its leaflets do not close tightly. This allows blood to flow backward within the heart and may cause symptoms such as shortness of breath and swelling in the abdomen, legs or neck.

A tricuspid device is implanted on the heart with a catheter.
A tricuspid valve is implanted in the heart via catheter.

The EVOQUE tricuspid valve replacement system is an investigational device designed to replace native tricuspid valve without open-heart surgery. The valve is implanted using a minimally invasive delivery system (catheter) through the femoral vein reaching to the heart.

The UCSF multidisciplinary heart valve team performed the tricuspid valve replacement as part of the TRISCEND II clinical trial evaluating the safety and effectiveness of the EVOQUE system. Patients are monitored throughout the procedure and after implantation of the device, requiring follow-up visits over a five-year period.

“Patients suffering with debilitating symptoms as a result of tricuspid regurgitation represent a large and significantly underserved patient group,” said Elmariah, UCSF associate professor of medicine. “The use of EVOQUE tricuspid valve replacement system represents a major improvement for patients who have a shorter recovery than with traditional surgical approaches.”

Improve Care for Heart Valve Disease Patients

In a separate case, the UCSF team also performed an innovative mitral valve transcatheter edge-to-edge repair (TEER) using the Pascal Precision system which was recently approved by the U.S. Food and Drug Administration.

The TEER procedure was performed on a patient with mitral regurgitation – a condition in which the leaflets of the heart’s mitral valve do not close properly and blood flows backward from the left ventricle into the left atrium during contraction of the heart muscle. Because of this condition, it is difficult for the heart to move blood through to the rest of the body efficiently. Symptoms include feeling tired or out of breath, and it may cause an overall decrease in quality of life.

Traditionally, mitral valve surgery required opening the chest and putting the patient on heart-lung bypass to keep blood circulating during surgery. More recently, UCSF clinicians have been performing minimally invasive mitral valve repair without having to open the sternum. Transcatheter mitral valve repair is a less invasive method performed through a small incision in the leg that uses a catheter delivery system in the femoral vein to reach the heart. A small device is then implanted to repair the mitral valve.

Surgeons perform a minimally invasive heart procedure. They look at echocardiograms on a large screen.
UCSF surgeons perform a novel amitral valve transcatheter edge-to-edge repair (TEER) using the Pascal Precision system which was recently approved by the U.S. Food and Drug Administration.

Transcatheter edge-to-edge repair of the mitral valve approximates the anterior and posterior mitral valve leaflets by grasping them with a clipping device in an approach similar to a treatment developed in cardiac surgery called the Alfieri stitch. The Pascal System is engineered with a catheter and handle, and is designed for maneuverability and stability, enabling precise navigation and implant delivery. The implant is secured to the leaflets of the mitral valve and the central spacer acts as a filler in the regurgitant opening.

The patients for each of the procedures are recovering well. One patient went home four days after the tricuspid procedure, and the other, the morning after the mitral valve procedure – much shorter in-hospital durations than for open surgeries.

Elmariah is an expert in transcatheter heart valve procedures, including TEER, transcatheter aortic valve replacement (TAVR), and transcatheter mitral valve replacement (TMVR). He also specializes in assessing new medical devices for repairing or replacing the heart’s tricuspid valve.

The goal of Elmariah’s research is to advance transcatheter and other surgical procedures for heart valve disease to maximize patient health and outcomes. He currently leads several clinical trials focused on valvular heart disease. These include landmark studies testing new transcatheter devices that treat heart valve disease without the need for open heart surgery. He and his research team are also investigating how to increase access to heart valve disease treatments and improve patient involvement in the management of their own care.

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked specialty hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit Follow UCSF Health on Facebook or on Twitter.