Dr. Gott: MVP patient asks about MitraClip procedure
DEAR DR. GOTT: I learned I had mitral-valve prolapse (MVP) about 40 years ago and have had it monitored ever since. I am now 65 and otherwise healthy. I have always had spells where my heart would start beating real fast, but they have been more recent lately, occurring almost once a month.
About four years ago, my cardiologist put me on 20 milligrams lisinopril daily. My blood pressure is 135/80. Since then, we moved from California to Arkansas. Last month, a new doctor took me off lisinopril and prescribed 60 milligrams diltiazem twice a day. He referred me to another cardiologist. The new cardiologist wants me to start taking 240 milligrams Pradaxa instead and suggested I undergo valve repair ASAP.
The surgeon he is referring me to repairs by splitting the breast and putting a ring around the valve. My research shows newer and less intrusive methods for repairing mitral valves (like the MitraClip). Can you refer me to a doctor in Arkansas that does these new procedures? What do you think about the procedure and starting the Pradaxa?
DEAR READER: The New York Daily News ran an article on this subject almost a year ago, following years of apparent successful use in Europe. Reports were the tiny medical clip might literally save millions of Americans from open-heart surgery. Mitral regurgitation affects more than 8 million people in the United States. The clip is reported to be far safer than surgery and nearly as effective. In fact, a study presented at an American College of Cardiology conference at that time found more complications (sixfold) from surgery than experienced by those who got the clip. It is important to note that the company that manufactures the MitraClip funded the study; nevertheless, doctors called it a turning point for advanced procedures.
Here’s the glitch. While the clip is commercially available in Europe, from what I can understand, it has yet to receive FDA approval in the United States, even though the procedure has been performed numerous times here under FDA protocol. Without FDA approval, insurance companies might not cover the procedure, and there might be restrictions.
The system includes a catheter-based device delivered to the heart through a blood vessel in the leg. It is designed to reduce significant regurgitation by clipping together the leaflets of the mitral valve. Repair with the clip is performed by physicians in the catheterization laboratory. Because the heart beats, there is no need for heart-lung bypass-machine involvement.
This is a highly personal decision and shouldn’t be made lightly and without the advice of your physicians. If the procedure is as good as it sounds, your recuperation will be minimal, and your body will be less traumatized; however, it may not be available to you. Ask your physician for a referral to a cardiologist for a second opinion. Reach out to a large teaching facility in your area or call your state medical society for their suggestions. I congratulate you for taking the initiative to educate yourself regarding the newest procedures for mitral-valve prolapse. Keep in mind that you may be a candidate for other, less invasive procedures to correct your MVP.
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