Physicians at Cleveland Clinic Abu Dhabi have successfully performed a valve-in-valve transcatheter mitral valve replacement (VIV-TMVR) in a clinical first for the United Arab Emirates.
The 77-year-old patient, Sfeir Iskandar, who had a history of prior coronary artery bypass graft surgery (CABG) and mitral valve replacement, was referred to the specialists at Cleveland Clinic Abu Dhabi with recurrent heart failure. He was found to have severe mitral valve regurgitation and failure of his mitral valve. His complex case was further exacerbated by multiple medical problems, having previously suffered a stroke, and been diagnosed with kidney disease, while also being significantly frail.
Multiple hospitals had told him that any repeat surgical intervention carried too high a risk.
Dr Ahmad Edris, Interventional Cardiologist at Cleveland Clinic Abu Dhabi’s Heart, Vascular and Thoracic Institute, explained: “We are at a stage in our structural heart programme that we can treat very complex valvular heart disease cases using minimally invasive techniques with excellent outcomes.”
Dr Edris is the co-director of the structural heart programme with Dr Mahmoud Traina. Both work collaboratively with the cardiac surgery team to make the best treatment decision for each patient.
The treatment involved using a transcatheter heart valve, typically used in the aortic valve position for transcatheter aortic valve replacement (TAVR). The valve was delivered across the interatrial septum from the right to left-side of the heart after making a puncture in the septum and delivered to the mitral position. The procedure was performed in collaboration with the structural heart team physicians at Cleveland Clinic Foundation, in the United States, via web conference.
Dr Edris said: “The success of this procedure is all in the planning, with meticulous attention to detail. It still amazes me that we can perform valve replacement like this with no more than a small puncture through the skin and vein, allowing the patient rapid recovery and discharge from the hospital in two days.” Dr Ahmed Bafadel helped with cardiac CT planning and procedural imaging.
Dr Edris said: “I don’t know whether patients or families truly understand the importance of seeking cardiac evaluation and treatment early in their heart condition. We often see patients at the end-stage of their disease process when it carries the highest risk of death if left untreated.”
Sfeir said: “I knew that I needed help but everywhere I went I kept hitting a dead end and nobody was either willing or able to treat me. That was why I was so relieved when I was referred to Cleveland Clinic Abu Dhabi. Dr Edris and his team were excellent. They really put my mind at ease and I was back in my own home within two days.”
Cleveland Clinic Abu Dhabi currently performs more than two-thirds of all structural heart disease cases in the UAE with outcomes that are on par with the best programmes in the world.
“We are lucky to have an amazing and collaborative cardiac surgery, cardiac imaging, anaesthesia and nursing team,” noted Dr Edris. “We could not achieve the same level of success without the structural heart team we have here at Cleveland Clinic Abu Dhabi.”
