A decade ago, critically complex cardiac patients had limited treatment options and were left with one option: to undergo high-risk open-heart surgery.

In 2011, a new, minimally invasive treatment option in interventional cardiology was approved by the U.S. Food and Drug Administration after years of rigorous clinical trials. Instead of getting a new heart valve via open-heart surgery, some patients could opt to have the new valve implanted during a catheter-based procedure called transcatheter aortic valve replacement (TAVR). The technology not only saved lives, but also jump-started a revolution in our approach to managing complex and structural heart conditions using minimally invasive techniques.

The interventional cardiology team at Cedars-Sinai has performed more TAVRs and transcatheter mitral value replacements (TMVR) than any other center in the U.S., with outcomes that place Cedars-Sinai among the top-performing programs nationally. Cedars-Sinai cardiac interventionalists also have played a leading role in developing minimally invasive, catheter-based procedures for all four heart valves—and are currently making exciting advances in the treatment of mitral and tricuspid valve disease with transcatheter valve replacement.

Today, the Interventional Cardiology Program at Cedars-Sinai has expanded the minimally invasive treatment options to tricuspid regurgitation and aortic regurgitation. A leading center for the EVOQUE trial, this innovative procedure is a minimally invasive, self-expanding valve designed to treat patients with moderate or greater tricuspid regurgitation via femoral venous access.

Through the availability of JenaValve trial, we now have the capability to offer minimally invasive TAVR procedures to patients with significant aortic regurgitation. The JenaValve system features an adaptative device design that “clips” the native valve leaflets that could be specifically suited to the aortic regurgitation anatomy.

"Thanks to our technology, now a decade later, patients with almost any heart ailment have minimally invasive treatment options to choose from," said Raj Makkar, MD, Cedars-Sinai’s vice president of Cardiovascular Innovation and Intervention and the Stephen R. Corday, MD, Chair in Interventional Cardiology.

Open-Heart Surgery Now Minimally Invasive

Conventional techniques of the past, including traditional approaches to cardiac surgery, are no longer the norm at the Smidt Heart Institute. Patients who must undergo heart surgery also benefit from minimally invasive surgical techniques that result in fewer complications and reduced length of hospital stay.

This is especially true for patients with mitral valve regurgitation. Joanna Chikwe, MD, Chair of the Department of Cardiac Surgery and a world leader in minimally invasive surgical approaches, says surgery—including robotic-assisted surgery—to repair or replace a leaking valve can relieve a patient’s debilitating fatigue, prevent complications like heart failure and stroke, and restore normal life expectancy.

“If robotic surgery makes sense for a patient, it can be a nearly pain-free way of restoring normal life expectancy,” said Chikwe, the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery and a professor of Cardiac Surgery as Cedars-Sinai. “Robotic surgery allows us to repair a leaky mitral valve through a small incision­—no bigger than a driver’s license—between the ribs. Most patients are home within three to four days.”

The surgery also is safe, says Chikwe.

“Upward of 95% of mitral valve surgeries we perform are done robotically,” said Chikwe. “And the complication rate for these procedures at Cedars-Sinai is less than 0.5%.”

Nation’s First Minimally Invasive Lung Transplant

Cardiac surgeons at Cedars-Sinai are also pioneering other innovative minimally invasive surgical options, including what is considered the nation’s first double lung transplant using a new, minimally invasive technique developed at Cedars-Sinai.

 

Most recently, Smidt Heart Institute cardiac surgeons also performed a groundbreaking robotic-assisted lung transplant.

“Witnessing these state-of-the-art procedures was like watching the field of U.S. lung transplantation move forward 15 years, in just minutes,” said Chikwe, who also oversees lung transplant surgery at Cedars-Sinai. “We have one of the most experienced transplant teams in the world, and it’s remarkable to watch how they change patients lives each and every day.”

Innovation for the Congenital Heart Patient

The benefits of minimally invasive techniques extend to the smallest of patients, including babies born with heart malformations.

Evan Zahn, MD, director of the Guerin Family Congenital Heart Program in the Smidt Heart Institute, recently served as the principal investigator for a clinical trial for a new device—Amplatzer Piccolo Occluder—that expands minimally invasive therapy options for many patients born with a condition called patent ductus arteriosus. Such patients, who are often delicate premature babies, would otherwise have needed major surgery and prolonged hospital stays. This novel closure device, which is performed at the bedside, stops blood flow through the ductus arteriosus.

“The approval of this novel device for congenital heart disease patients expands the population we can treat from about 15% to roughly 90% of patients,” said Zahn. “In addition to this remarkable expansion, the procedure is met with minimal complications, limited side effects and quick recovery times.”

The Smidt Heart Institute at Cedars-Sinai is dedicated to leading the way for novel treatment options and pioneering the way for improved patient care.

You can also call Interventional Cardiology at 424-315-2242, Cardiac Surgery at 424-315-4589, and Congenital Heart at 424-315-2411.