Baptist Health first in Florida to perform FDA-approved Transcatheter Mitral Valve In Ring procedure for high-risk heart valve repair

Baptist Heart Specialists' is once again leading the way in minimally invasive, high-risk heart valve repair. Siddharth Wayangankar, MD, MPH, FACC, FSCAI, RPVI, interventional cardiologist, and Nathan Bates, MD, cardiac and thoracic surgeon and chief of cardiac surgery, Baptist Medical Center Jacksonville, have performed the first Edwards Lifesciences Transcatheter Mitral Valve In Ring procedure (TMVIR) in Florida following FDA approval of the procedure. TMVIR is used for fixing failing mitral valve repairs (prior mitral valve surgical repair with a ring) in patients where a second open-heart surgery is considered too risky.

Blood that flows between different chambers of a heart flows through valves. The mitral valve is between the two chambers on the left side of the heart. When certain medical problems affect the performance of these valves, replacement valves and rings made from different materials may be surgically placed to facilitate blood flow. Some may last for a couple of decades, and others can wear out and need to be replaced. Often, patients with rings who require the second repair are not good candidates for another open-heart surgery. This is when the TMVIR procedure can be helpful.

Much like a washer can help stop a failing or leaky faucet, with TMVIR, a bioprosthetic aortic valve (TAVR valve) is reversed in direction and placed into the failing mitral ring and deployed with balloon inflation. The new valve starts working immediately, and the original mitral valve's narrowing or leakage is immediately fixed. It is a minimally invasive procedure using a catheter inserted in the groin, which means patients can avoid a second open-heart surgery, and go home the day after the procedure.

"This is going to dramatically change the way we treat patients with prior mitral valve surgeries. In this first procedure, the patient had already had two open-heart surgeries, and another one to fix the mitral valve was not possible," said Dr. Wayangankar, who is a national and international proctor for transcatheter mitral valve repairs (TMVR) procedures. He has been involved in structural heart programs at the Cleveland Clinic (Cleveland, Ohio) and UF Health (Gainesville), and is now bringing his skills to Northeast Florida and Southeast Georgia at Baptist Health.

In addition to Dr. Wayangankar and Dr. Bates, the team of experts involved in the first use of TMVIR at Baptist Health, included:

• Praveen Kanaparti, MD, FACC, FSCCT, RPVI, cardiologist, medical director of Advanced Cardiac Imaging, who performed the pre-procedural CT scan and provided precise measurements and finer anatomic details specific to the patient that contributed to the ultimate successful outcome;

• Carlos Zamora, MD, FACC, cardiologist, medical director of Echocardiography at Baptist Health Jacksonville, who was the intraoperative procedural imaging specialist;

• Pamela Rama, MD, FACC, cardiologist, medical director of Cardio-Pulmonary Rehabilitation Beaches, who was the patient's referring cardiologist and is responsible for the post-op medical management;

• Ruby Satpathy, MD, FACC, FSCAI, interventional cardiologist and medical director of the Structural Heart Program at Baptist Jacksonville, who helped formulate pre-procedural strategy and identify potential challenges that could have been encountered during the procedure.

"These procedures require extensive planning, multi-specialty, collaborative strategies focused on pre-procedural planning, imaging guidance during the procedure, and extensive skills," said Dr. Wayangankar. "We are lucky to have a group that provides all of this, and make such technically challenging cases possible."

"We are pleased to be at forefront of innovation and provide state-of-the-art, cutting edge structural heart procedures with excellent outcomes to the Northeast Florida and Southeast Georgia community," said Dr. Satpathy, who is a national proctor for TAVR and Mitral Clip and has been performing transcatheter valve interventions for more than 10 years. She has also written and co-authored expert consensus documents about management of mitral valve disease and transcatheter mitral valve interventions for the American College of Cardiology (ACC), Society of Thoracic Surgeons (STS) and Society of Cardiovascular Angiography and Interventions (SCAI).

Baptist Heart Hospital is Northeast Florida's only freestanding hospital for heart and vascular care, and is the centerpiece of Baptist Health's top-ranked heart and vascular program. It is home to more than 500 team members and physicians who have specialized training in inpatient and outpatient cardiovascular and thoracic care.