Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.
From the OHSU Knight Cardiovascular Institute
Firas Zahr, M.D.
Dr. Zahr is the director of Interventional Cardiology and the co‑director of the OHSU Complex Heart Valve Program. His chief interest is pioneering minimally invasive approaches to treating complex heart and valve diseases.
For patients with mitral regurgitation caught in the revolving door of hospitalizations and ineffective medical therapy, recent breakthroughs in treatment can have a significant impact on quality of life.
OHSU is one of the few sites in the region that can offer percutaneous intervention for mitral valve disease. We have four clinical trials evaluating transcatheter options for mitral valve repair and replacement for both degenerative and functional mitral regurgitation.
Our enrollment has been among the highest in the nation, giving OHSU the most experience, the most treatment options, and the largest patient pool in the country.
For this procedure, our specialist team at the OHSU Complex Heart Valve Clinic evaluates each patient in a single session for all traditional and transcatheter treatment options for their mitral regurgitation.
If a percutaneous intervention is the right fit, patients do not need cardiopulmonary bypass, frequently procedures can be done from the groin, so there is less toll on the body and faster recovery.
Most patients are in the hospital less than a week and some only require an overnight stay. Our transcatheter patients rarely need rehabilitation before returning to their homes.
Anatomy key to patient selection
Patients at high surgical risk or who have previous valve surgeries are good candidates for percutaneous intervention. By having multiple trials available, some patients who don’t qualify for one device may qualify for another.
The primary qualification for transcatheter mitral valve replacement is anatomical. At this stage in development, there are only a limited number of valve sizes available, so it is a key determinant of whether this option is suitable for a patient.
Evaluate early for most options
It’s never too soon to refer for an evaluation of your mitral regurgitation patients.
We are treating mitral regurgitation earlier and earlier, before the disease becomes too advanced.
If patients are not feeling well on medical therapy, there may be a surgical or transcatheter option, even for older or less healthy patients. There is no age limit on these transcatheter procedures.
We will treat patients as long as we think they will benefit from the therapy and can tolerate it. Our goal is to improve their symptoms and get them out of the hospital quickly and back into their communities.
When to refer
- Symptomatic patients with significant valvular disease.
In addition to aortic and mitral valves, there are now procedures for the tricuspid and pulmonic valves as well.
All of these transcatheter-based procedures are minimally invasive, which allows for faster recovery and no general anesthesia for most patients. In most cases, patients spend a night or two at OHSU and then return to the care of their local providers.
We repair their blockage or leak, leading to improved heart failure symptoms and quality of life, and may prolong life in some cases. Importantly, these new techniques represent options for people who previously had none. For example, an older patient who isn’t tolerating medication or for whom medical therapy isn’t effective.
The OHSU Complex Heart Valve Clinic embraces a multidisciplinary approach with patients seen jointly by an interventional cardiologist, echocardiologist and cardiac surgeon.
We are available to answer questions about all treatment options for heart valve disease. Please call the OHSU Physician Advice and Referral Service at 503-494-4567. To refer a patient, please fax to 503-346-6854.