Leading expert in mitral valve repair and transcatheter therapies, Dr. Francesco Maisano, MD, shares two powerful patient stories. He explains how listening to patient wishes is critical in heart treatment. Dr. Francesco Maisano, MD, discusses the life-changing potential of MitraClip procedures for severe mitral regurgitation. He emphasizes the importance of offering unbiased treatment options. Patient-centered care can fulfill dreams and achieve excellent clinical outcomes.
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Mitral Valve Repair Success Stories: Patient-Centered Care in Cardiology
Jump To Section
- Listening to Patient Wishes
- MitraClip for Heart Failure
- Fulfilling Patient Dreams
- Tailoring Treatment Options
- Unbiased Medical Advice
- Full Transcript
Listening to Patient Wishes
Dr. Francesco Maisano, MD, highlights a fundamental principle in cardiac care. He stresses that physicians must listen carefully to patient wishes. This approach forms the cornerstone of effective and compassionate treatment. Dr. Anton Titov, MD, facilitates this discussion on patient-centered decision-making.
Understanding a patient's personal goals and lifestyle needs is crucial. It ensures the chosen treatment aligns with their desired quality of life.
MitraClip for Heart Failure
Dr. Francesco Maisano, MD, recounts treating a patient with severe functional mitral regurgitation. The patient had a very low ejection fraction of 18-20%. This case occurred in 2008 during the early development of the MitraClip procedure.
At the time, the patient was considered "non-Everest-like," a high-risk category. The medical team debated the procedure's potential benefits. Despite initial uncertainty, the MitraClip was performed. The patient survived for an remarkable 12 years after the treatment.
Fulfilling Patient Dreams
The patient's primary wish was simple yet profound: to breathe easier and walk again. He expressed a dream to complete the Santiago de Compostela pilgrimage walk. Dr. Francesco Maisano, MD, initially found this ambitious for a NYHA Class 4 patient.
The MitraClip procedure successfully reduced the mitral regurgitation. One year later, the patient returned with a passport full of stamps from his pilgrimage. This story demonstrates that new technologies can help fulfill patient dreams previously thought unreachable.
Tailoring Treatment Options
Dr. Francesco Maisano, MD, describes a second case involving an entrepreneur with Barlow's disease. The patient had a flail A2-A3 mitral valve and requested a MitraClip. He wanted a quick return to his busy business life in Monte Carlo.
After reviewing the echocardiogram, Dr. Maisano determined the anatomy was unsuitable for the early-generation MitraClip. The flailing involved half of the mitral valve, a complex scenario. He instead recommended and performed a minimally invasive surgical repair.
Unbiased Medical Advice
This second story underscores the value of offering a full spectrum of therapies. Dr. Francesco Maisano, MD, explains that his ability to perform both transcatheter and surgical procedures removes bias. He can provide truly objective advice based solely on the patient's best medical interest.
The entrepreneur recovered quickly and discharged himself after one week. He returned to work with a fully competent mitral valve. Dr. Anton Titov, MD, and Dr. Maisano agree that credible, unbiased information empowers patients to make correct decisions with their doctors.
Full Transcript
Dr. Francesco Maisano, MD: I will tell you two stories about my patients. They are very short stories. I have hundreds of stories, but the first story I have in mind is a patient who came to me with functional mitral regurgitation and heart failure. This patient underwent the MitraClip procedure. We are in the year 2008, at the very beginning of the MitraClip development. At that time, we divided patients into Everest-like or non-Everest-like treatment selection criteria based on Everest clinical trials. He was a non-Everest. He had an ejection fraction below 20% or 18%. We debated whether MitraClip was a good idea or not.
When we treated these patients, we didn't know yet what to expect from them. Today we would say this patient was in a non-coaptation risk category. This patient had functional mitral regurgitation, and so a patient would probably not respond to therapy. This patient died one year ago. He survived for more than ten years after the procedure, for 12 years, actually. I don't know if we prolonged the length of his life. This is not part of a randomized clinical trial, but for sure, he lived 12 more years.
What is more important for me is this. What do I have at my house, office, and room? I have a picture of the dream of this patient. This patient came to me when we were discussing the opportunity of doing or not doing the heart treatment procedure. I said, what do you want? What do you expect from this procedure? He said, I would like to breathe. I have a dream that I can walk again. If I can walk again, I will go and do the Santiago walk. I will walk to Santiago de Compostela to thank God for the miracle. I was laughing. This guy was in NYHA Class 4 and unable to walk 20 meters. Okay, listen, if you go there, send me a picture. We did the procedure.
Mitral regurgitation was reduced, but it was not a tremendous reduction. It was a pretty good reduction. Then, one year later, the patient came to me for a follow-up visit with a passport of the Santiago de Compostela walk. For these people, they walk 100 kilometers and get stamped at every station they pass. He brought me a full passport full of stamps. What this story tells me is that when we do our job, we need to help people. Again, I don't know if I can prolong the time of life. I don't know if I prolonged this guy's life, but I was able to fulfill his dream. With new technologies, we can fulfill dreams which were not reachable without them.
The other patient's story is the opposite. There was a patient who came to me because he wanted a MitraClip. He knows I'm a MitraClip expert. This guy is an entrepreneur with offices in Monte Carlo. He has a flail A2-A3 mitral valve. He comes to me and says, I was to another colleague of yours, who is very famous, a cardiology leader in Monte Carlo. He said he could operate on me but only to cut me open. I cannot stop. I have a lot of business. I need to have a non-invasive procedure. So he said, can you do me a MitraClip? I see that this is a treatment method after which I can work the next day. I said, so let's see, let's watch your echocardiogram. I started watching the echo, and as I watched, I thought, oh my god, this is a flailing of half of the mitral valve. I'm not sure that I'm going to be able to really solve your problem.
Probably today it would be possible because today we have longer clip arms, but at that time we had only the original MitraClip with shorter arms. This patient had Barlow's mitral valve disease with a flailing of half of his mitral valve. I cannot really do that. Think about your health. I understand you are a businessman, but I will do whatever I can to make you up and running as fast as possible. I will do your heart surgery minimally invasively. So I did it. The guy one week after the procedure is fine. He discharged himself from the hospital against my will, but he went back to work with a completely competent mitral valve. It was a very good result. He had an active life.
This story tells you another aspect of our profession, my personal pathway. Being able to provide the full spectrum of therapy allows me to inform the patients without any bias and also to be credible. If I say to the patient, it is better to do something else, it's not because I want that something else, but because I know I can do both and I know it's better for you. This patient is another lesson—that we need to adapt to the patients. But also we need to provide good information, unbiased information, so that the patient will decide correctly together with us.