Physicians successfully carried out a pioneering valve-in-valve transcatheter mitral valve replacement

Abu Dhabi, United Arab Emirates - June 01, 2022:  Physicians at Cleveland Clinic Abu Dhabi, a Mubadala Health partner, 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 (valve leaking) and failure of his mitral valve. His complex case was further exacerbated by the fact that he had 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, and nothing could be done. But that changed when he was transferred to Cleveland Clinic Abu Dhabi. 

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 program that we can treat very complex valvular heart disease using minimally invasive techniques with excellent outcomes”. Dr. Edris is the co-director of the structural heart program with Dr. Mahmoud Traina and 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 (tissue between the right and left side of the heart) 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 from cardiac imaging helped with cardiac CT planning and procedural imaging. 
Valve disease continues to be prevalent in the United Arab Emirates. Symptoms include a slow decline in functional ability and shortness of breath with exertion which, if ignored, can have serious consequences. For example, approximately 60-70% of symptomatic severe aortic stenosis continues to go untreated despite the available non-invasive treatment options. 

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 programs in the world. 

“We are lucky to have an amazing and collaborative cardiac surgery, cardiac imaging, anesthesia 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.”