An avid tennis player in his earlier days, Robert Boxer’s knees are not as good as they once were. At 85, going up a flight of stairs can be a bit uncomfortable, but, until recently, he had never struggled to breathe. That was when he knew his heart was failing.
“I was often short of breath and medication wasn’t helping,” Bob said.
Bob, a retired allergist, had a history of cardiac health problems. He was diagnosed with coronary artery disease in the early 2000s. When he was 70, Bob had a heart attack that led to triple bypass surgery to restore blood flow to his coronary artery. It was a difficult recovery, made worse by the fact that he was later diagnosed with degenerative mitral regurgitation, a progressive disease of the heart’s mitral valve.
“When Robert’s heart muscle contracted, a significant portion of blood leaked backwards toward the lungs,” said Michael Salinger, MD, a Froedtert & MCW interventional cardiologist. “In Robert’s case, it was because the mitral valve leaflet had weakened and was no longer closing properly.”
Mild to moderate leakiness of the mitral valve is typically treated with medication and regular echocardiograms (noninvasive sound wave testing) to monitor the mitral valve’s functions. When the tests showed worsening regurgitation and Bob’s symptoms did not respond to increased medication, Dr. Salinger knew it was time to intervene.
A traditional approach for a patient in this situation would be open heart surgery to repair the mitral valve, but given Bob’s cardiac history, he was not a good candidate for another invasive heart procedure. Instead, Dr. Salinger performed a minimally invasive catheter-based procedure and repaired the valve using the MitraClip® device. Entering through a vein in Bob’s leg, Dr. Salinger used the MitraClip, which is about the size of a dime, to stop the leakage.
“We were able to reduce the leakage from severe to moderate,” Dr. Salinger said. “The MitraClip doesn’t stop regurgitation completely, but in patients who have a high surgical risk, this is often an excellent solution that alleviates their symptoms.”
MitraClip is a recent innovation, and Dr. Salinger was involved in the first U.S. implant of a MitraClip in the original clinical trial in 2003. The device was approved by the FDA in 2013.
“We did many clinical trials over the years and learned that regurgitation doesn’t have to be completely resolved in order for patients to feel better,” Dr. Salinger said. “Also, the trials showed once the clip healed in place, the clinical improvements in patients who received the MitraClip procedure are just as durable over a five-year period as improvements in patients who had openheart surgery to repair their mitral valve.”
Bob’s MitraClip procedure was performed on April 12, 2018. He made the 90-minute drive to Froedtert Hospital from his home in the north suburbs of Chicago with his son. They stayed overnight in the Milwaukee area, and Bob returned home the following day.
“I could have gone to a hospital closer to home, but I have known Dr. Salinger for many years, ever since he practiced in Illinois,” Bob said. “His expertise in MitraClip procedures is unparalleled. Also, from the moment I set foot in Froedtert Hospital for my initial appointment, it was an exceptional experience. Everyone was very attentive and helpful, so I knew I would be well taken care of.”
After the procedure, Bob needed only to return to Froedtert Hospital for a 30-day follow-up appointment. His care team arranged for the rest of his follow-up appointments and his cardiac rehabilitation to take place at a hospital near his home in Wilmette, Ill.
“I’m improving each day and getting back to feeling like myself again,” Bob said. “My heart isn’t slowing me down.”