Researchers at Western and the Lawson Health Research Institute played a leading role in a new global study that is changing the way surgeons repair leaking heart valves.
Leaky flap is one of the most common heart conditions and often does not cause symptoms. Many patients do not even notice that they have a leaking flap, and often they only come to the doctors late in the course of the disease.
“If mitral valve leakage is not corrected, the patient will have problems with fluid retention, shortness of breath, and heart failure,” said Dr. Michael Chu, one of the study’s leading researchers. “It will then lead to complications requiring hospitalization and ultimately an increased risk of death.”
There are two interconnected valves in the heart that can potentially leak and lead to additional complications: the mitral valve and the triangular valve. Traditionally, the mitral flap is first surgically repaired in the belief that it will result in improvements to the triangular flap. However, scientists have found that this is not always the case.
“We were worried that if we just fixed the mitral flap, would the triangular flap still leak?” said Chu, who is also chairman of the Department of Cardiac Surgery at the Schulich School of Medicine & Dentistry.
To answer this question, the research team participated in a multicenter, randomized study conducted by the Cardiothoracic Surgical Trials Network, a clinical research network of the U.S. National Institute of Heart, Lung, and Blood. The study was conducted in 39 hospitals around the world in more than 400 cardiac patients.
Chu and his team in London worked with patients through the London Health Sciences Center. Patients were randomized, with half receiving mitral valve repair alone and half receiving mitral valve repair and three-dimensional repair surgery at the same time.
“Two years after surgery, we found that the group that had both mitral and triangular flap repair had significantly less severe residual triangular flap leakage,” Chu explained. “These findings suggest that simultaneous three-dimensional repair is highly effective, and for patients with three-dimensional leakage, both valves should be repaired simultaneously.”
The research results have been published in a journal New England Journal of Medicine. Chu, the first author of the paper, believes this study will have a significant impact globally on how surgical teams repair leaking heart valves and improve patient outcomes.
“This research is really important because it makes it very clear that we should fix both valves at once to try to reduce patients’ future complications, ”he said.
In the future, study participants will be followed for five years, and various aspects of the study will be further explored, with the ultimate goal of improving patient long-term outcomes.