Mitral valve repair works for big and small hearts

When our hearts get sick, sometimes the valves inside them do not work properly. One common problem is called secondary mitral regurgitation (SMR), which happens when the heart becomes damaged and the mitral valve starts to leak. This leak can make people feel very tired and short of breath, and it often means they have a higher risk of heart problems in the future. Scientists have been working hard to find the best ways to help people with SMR, especially those with very big hearts (severe left ventricular dilatation).

Understanding secondary mitral regurgitation and heart enlargement

The heart is like a pump with four rooms. When the lower left room (the left ventricle) gets damaged, it can get bigger and weaker. This can be caused by things like heart attacks or infections. When the ventricle gets too big, it pulls on the mitral valve, making it leak. This is SMR. Studies have shown that people with SMR and a weak heart do not do as well as those without leaks, and the bigger the leak, the higher the risk for health problems (JAMA Cardiology review).

New hope: Transcatheter edge-to-edge repair (TEER)

Doctors have a special procedure called TEER that fixes the mitral valve by clipping it together using a tiny device. Unlike open-heart surgery, TEER is done through a small tube, making it safer for people who are already very sick. Early studies, like the famous COAPT study, showed that TEER helps people with SMR feel better and go to the hospital less often (COAPT study). But another study, called MITRA-FR, did not find as much benefit (MITRA-FR trial), which made doctors wonder if TEER would work for everyone.

Does heart size matter for TEER success?

Doctors noticed that patients in the MITRA-FR study had much bigger hearts than those in the COAPT study. They began to ask: do people with very enlarged hearts get as much benefit from TEER? To find out, a new study looked at 158 patients with SMR who had TEER. The patients were split into two groups: those with very big hearts and those with smaller ones (original study).

Study findings: TEER helps, even in enlarged hearts

The researchers found that the TEER procedure worked just as well in both groups. Both the big-heart and small-heart groups had similar success rates in fixing the valve and felt better after the procedure. Even after one year and beyond, there was no real difference in survival between the groups. This means that even people with very enlarged hearts can benefit from TEER, just like those with smaller hearts.

It is important to note that some patients with very, very large hearts (extreme cases) were not included in the study. But for most people with severe heart enlargement, the results are hopeful. This supports what has been found in other research, such as the RESHAPE-HF2 trial, which looked at a mix of patients and saw similar benefits (RESHAPE-HF2).

For more about how mitral valve repair can help a wide range of patients, you can read the SlothMD article, Mitral valve repair helps hearts of all sizes, which explains how the TEER procedure brings hope even to those with very enlarged hearts.

What it means for patients

If you or someone you know has heart failure with a leaky mitral valve, this study is good news. Doctors should not decide against TEER just because the heart is very big. Every patient is different, but the procedure can help many people feel better and maybe live longer. The study also used new ways to measure heart size that work for people of different shapes and body sizes, making the results even more helpful for everyone (heart size measurements).

For kids curious about how science and health AI can help with rare heart and body problems, SlothMD also covers topics like understanding congenital disorders of glycosylation, which are rare conditions that affect many organs, including the heart.

Why research and technology matter

This research shows how careful studies and technologies like TEER and health AI can improve lives. By testing treatments in lots of different people, including those with big challenges, doctors can make sure everyone gets the best care. If you want to learn more about how doctors measure heart chambers and valves, check out the guidelines for heart measurements used by experts.

No matter your age or heart size, science and new technology are working to help people live their healthiest lives.