ST. GEORGE — A new heart procedure has been performed at St. George Regional Hospital that promises a less invasive procedure and not needing to leave town for those dealing with a type of leaky heart valve. 

Cardiologists at St. George Regional Hospital recently performed the first two MitraClip procedures where tiny clips were placed on the mitral heart valve of patients, repairing a debilitating condition without the need for a more invasive open-heart procedure. 

The first patient, a man from Mesquite, Nevada, went overnight from struggling to take a step to conquering a flight of stairs with ease.    

It’s a procedure that St. George Regional Hospital cardiologist Dr. Blake Gardner said is a progression of seven years of advances at the facility to keep major heart procedures local. 

“We have a very well-educated, Medicare-age population that demands a high level of care,” Gardner said. “There are not a lot of people are doing it. I believe that we’re just less than a handful of people in the state of Utah now that are (offering) this therapy.”

Gardner spoke to St. George News after coming out of performing another heart procedure, an alcohol septal ablation, which closes holes in the heart. 

Gardner and Dr. Ryan Van Woerkom were trained in the procedure by cardiologists at the Intermountain Healthcare Heart Institute in Salt Lake City. They were among the first in the state to perform the procedure.

Up until now, if a resident of Southern Utah was dealing with mitral heart valve leakage they would have to travel out of town to get it fixed. Even then, they might face a complex surgery that requires opening the heart. Either a ring-like device is attached or the valve is replaced entirely with one that is artificial or from another human or animal. 

Even if it was the same procedure up in Salt Lake City, Gardner said it’s just better for a person’s mental health to stay close to home, and that could mean an easier recovery. 

“Whenever you have some of these bigger heart procedures, there’s a lot of emotional, psychological things that go with it. And so being close to family and or home is actually a big deal,” Gardner said. “When you go, you go up there people have to find a hotel for family and ‘how long are you going to be there and transitioning to outpatient?’ And so it becomes somewhat of a hassle.”

According to the Cleveland Clinic, more than 10% of people suffer through a leaky heart valve at some point, and a mitral valve leakage is the most common. It is also one of the more difficult to treat. 

“There’s four heart valves and the two ones that typically give us some of the biggest problems are the aortic and mitral valve. And over the last decade, there’s been enormous advancement in the aortic valve arena where we can fix anything with very minimally invasive techniques now, as opposed to having to open everyone’s chest,” Gardner said. “The mitral valve is much trickier just because it’s a very difficult valve to get to from a minimally invasive standpoint.”

A heart valve is kind of the door into the heart, opening and closing with each heartbeat as blood in need of oxygenation enters, then leaves. The heart has four of these “doors.”

With a leaky valve, according to the Cleveland Clinic, not enough blood gets pumped to the rest of the body and forces the heart to work harder.

At the least, a person may be able to get by with few to no symptoms. But the worse it is, it can make just the act of going up a step or two as laborious as a distance race in the Olympics. At its worst, it can lead to cardiac arrest and death. 

The procedure

To put it simply, the clip procedure versus full valve replacement is the difference between tightening a leaky pipe under the kitchen sink to stop a leak and replacing the pipe entirely. 

In the surgery, a small tube with a tool at the end is inserted into a vein in the leg and guided to the heart. Then, a tiny clip is attached to the mitral valve, allowing it to close normally without leakage and return to normal function. 

“You go in and you clip it and you tighten it essentially,” Gardner said. 

As easy as Gardner may make it sound, it may be akin to Joe Ingles talking about how easy it is for him to shoot three-point shots for the Utah Jazz. Easy for him, probably not for others. And Gardner admits, the MitraClip procedure isn’t an easy shot to make.

“It’s one of the more difficult procedures I’d say. It’s way behind the three-point line,” Gardner said. This is one of the technically more difficult procedures that we do. It takes a lot of resources. A lot of training. There’s a lot of micro-movements.”

And it’s a three-person job between Gardner, Van Woerkom and an advanced cardiac imager. 

The clip procedure doesn’t replace all mitral valve repairs. Some patients with more severe forms of mitral valve leakage might still need an open-heart procedure. But for many, the clip procedure is a new option that also means a shorter stay in the hospital after surgery. 

“I think the anxiety that patients have about open-heart surgeries gets reduced significantly as we start to move forward with more of these structural heart procedures,” Gardner said. “If you had to have a heart procedure 25 years ago, it’s very likely it was going to be an open heart and that is no longer the case.”

And not having invasive open-heart surgery has another benefit – much less time in a hospital bed with hospital food. 

“The burden to the patient is drastically different,” Gardner said. “They can go home the next day and live their life for the most part as opposed to the traditional open-heart surgery.”

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