The heart valve, made from animal tissue, is delivered through a catheter from the patient’s groin to the heart to replace the patient’s own defective valve. Certain drugs designed to reduce diabetes have also been shown to reduce heart failure. Drugs that mimic hormones instruct the body to perform biological functions that protect the heart.
These are just some of the recent innovations in heart care that are saving countless lives.
“The number of [advances] What has happened over the past 20 years is truly extraordinary,” says Stephen E. Nissen, MD, chief academic officer of the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic in Ohio. “[Some] It’s a game changer that will have a huge impact on public health. ”
Here are five advances that doctors and researchers tout as having a big impact on patients’ lives.
Transcatheter aortic valve replacement
Aortic valve stenosis (AVS) occurs when the opening of the aortic valve (the valve through which blood passes from the main pumping chamber, the left ventricle, through the aorta and out of the body) becomes narrow, reducing blood flow from the heart to the aorta. It happens. . It can cause chest pain, fainting, and fatal heart failure. According to the Frankel Heart and Vascular Center at the University of Michigan Health, as many as 300,000 people in the United States are diagnosed with AVS each year.
For many years, the treatment for the most severe cases was open-heart surgery to repair or replace the damaged valve. Because the disease often develops as people get older, many patients are not suitable for these major surgeries due to the risk of complications.
Transcatheter aortic valve replacement (TAVR) provides a less invasive alternative to major surgery by introducing a replacement valve into the heart through a catheter. The doctor makes a small incision in the groin or chest, inserts a catheter into the artery, and uses imaging techniques such as X-rays to guide the replacement valve through the artery to the site of the damaged valve. The replacement valve (often made of bovine or porcine heart tissue) is compressed within the catheter and expands into place after delivery. (The American Heart Association provides a detailed explanation with illustrations.)
According to the American College of Cardiology, French cardiologist Alain Clivier, MD, is credited with being the first to successfully perform TAVR in France in 2002. The U.S. Food and Drug Administration (FDA) first approved the procedure in 2011 for certain patients who are most at risk for major surgery.
Subsequent studies have shown that TAVR is at least as effective, and in some cases superior, for low-risk patients with severe AVS. This procedure has been studied and refined through various trials, particularly the PARTNER (Aortic Transcatheter Valve Installation) trial conducted at many academic medical institutions, which led the FDA to recommend that all patients with severe cases of this disease We will gradually expand the approved use of This treatment is now commonly used as an alternative to open heart surgery.
SGLT2 inhibitor
In the early 2000s, clinical trials demonstrated the power of certain drugs to lower blood sugar levels in people with type 2 diabetes. These drugs inhibit the body’s ability to reabsorb glucose into the kidneys, a protein (SGLT2). This causes blood sugar levels in diabetics to become too high. Over time, doctors and researchers have discovered that these drugs, called SGLT2 inhibitors, can lower blood pressure, reduce plasma volume (reducing the work the heart has to do), and lower the sympathetic nervous system, thereby reducing the risk of heart failure and heart failure. It was discovered that it is effective in preventing the worsening of kidney disease. Activities.
Academic medical centers have played an important role in the development, purification, and research of SGLT2 inhibitors. A meta-analysis of five randomized controlled trials found that lancet in 2022 found that inhibitors “significantly reduce mortality and risk of heart failure worsening, and improve patient symptoms and overall health when added to standard treatment for heart failure.” The study was conducted by researchers from Harvard Medical School in Massachusetts, Yale University School of Medicine in Connecticut, Duke University Medical Center in North Carolina, and Northwestern University Feinberg School of Medicine in Illinois.
The FDA first approved the first SGLT2 inhibitor (canagliflozin) to treat type 2 diabetes in 2013, and from 2020 onwards it approved three other SGLT2 inhibitors to lower the risk of heart failure, heart attack, and cardiovascular death. Approved inhibitors (dapagliflozin, empagliflozin, sotagliflozin). For diabetics.
mitral valve clip
In mitral regurgitation, the mitral valve flap that controls blood flow from the left atrium to the left ventricle does not close properly. This can cause blood to flow back into the heart in the wrong direction. Many people do not experience symptoms for years, but as symptoms progress, they often worsen health problems such as shortness of breath, swelling of the extremities, shock symptoms (such as loss of consciousness), atrial fibrillation, and heart failure. there is.
According to , mitral regurgitation affects an estimated 1.7% of the U.S. population, with prevalence rising to approximately 9.3% for those over 75 years of age. American Heart Association Journal.
For years, people with severe mitral regurgitation have had to decide whether to risk open-heart surgery to repair or replace the valve or live with a potentially fatal defect. There was a need. MitraClip offers a less invasive option. The doctor guides the catheter into a vein in the patient’s leg to reach the heart. Through the catheter, a small cobalt-chrome clip with a polyester cover is attached to the valve to help it close more fully, Penn Medicine explains. The procedure will take 1 to 3 hours.
“For people who are too sick to undergo surgery, clipping the mitral valve can significantly reduce the amount of leakage,” Nissen says. “That’s a pretty big innovation.”
Research published last year New England Medical Journalshowed that the clip reduced the risk of mitral regurgitation, hospitalization, and mortality up to 5 years postoperatively. The study was conducted by researchers from a number of universities, including the Icahn School of Medicine in New York, the Cleveland Clinic, and the University of Colorado Hospital.
Development of MitraClip began in the late 1990s at Evalve (later acquired by Abbott), and the first patient implants were in 2003, Abbott said. The FDA first approved the procedure for certain critically ill patients in 2013 and gradually expanded approval to more patients.
GLP-1 agonist
Drugs such as Ozempic and Wegovy, which are widely used to treat diabetes and obesity, have recently been found to reduce heart attacks and strokes.
This drug (as described here) mimics the gut hormone (GLP-1) that triggers the release of insulin (which lowers blood sugar levels), suppressing blood sugar levels, slowing down digestion, and increasing satiety after meals. Enhances the feeling.
In 2017, the FDA approved the GLP-1 agonist Ozempic for the treatment of diabetes. The FDA approved Wegovy for weight loss in 2021, and Mounjaro (for diabetes) and Zepbound (for weight loss) in 2023.
According to a paper published in 2023, research shows that patients who took diabetes medications also experienced a significant reduction in adverse cardiac events. Frontiers of clinical diabetes in healthcare. The University of Texas Southwestern Medical Center study included the effects of GLP-1 agonists on glycemic control and weight loss, and the University of Vermont Medical Center study included cardiovascular outcomes.
“GLP-1 drugs are widely used in the treatment of diabetes and have been shown to reduce cardiovascular morbidity and mortality in the treatment of diabetic patients,” Dr. Nissen points out.
In addition to reducing cardiovascular risk factors such as blood sugar, weight, lipid levels, and high blood pressure, this drug stimulates the production of nitric oxide (which dilates blood vessels and increases blood flow), which helps reduce oxidative stress. (thus stabilizing antioxidant levels) and helps reduce inflammation.
Helping babies with congenital heart disease live longer
According to the Centers for Disease Control and Prevention (CDC), approximately 40,000 babies are born in the United States each year with congenital heart disease (CHD), the leading cause of infant morbidity and death associated with congenital disorders. This is the cause.
For the past several decades, babies born with severe cardiopulmonary disease have almost always died in infancy, often before their first birthday. Those with less severe disease routinely died by early adulthood. However, thanks to various medical advances, lifespans are gradually and significantly increasing. According to the CDC:
- 69% of babies born with severe CHD are expected to survive to at least 18 years of age
- 95% of people born with non-severe CHD are expected to survive to at least 18 years of age
- 81% of babies born with some type of CHD are expected to survive to at least 35 years of age.More and more babies are living into old age
As reported in a 2019 literature review, so many infants with CHD are now living longer that “the prevalence of CHD patients is shifting from infancy and childhood into adulthood. ” is reported. Acta Pediatrica (Journal of the Karolinska Institute, Sweden). According to the CDC, in 2010 (the last year for which a complete analysis is available), approximately 1 million children and 1.4 million adults in the United States were living with CHD.
Researchers and doctors attribute this change to numerous improvements in cardiovascular diagnosis and treatment that began decades ago and have continued to improve and become more common. They include:
- Methods such as fetal echocardiography (to assess the heart in the womb), pulse oximetry screening of newborns before hospital discharge, and infant diagnostic techniques such as echocardiography and magnetic resonance imaging (MRI) This allows for better detection.
- Advances in surgical interventions such as septostomy to initiate (in utero) treatment of cyanotic heart disease. This reduces the amount of oxygen delivered to your body. and a series of surgeries performed in the first few years of life to correct hypoplastic left heart syndrome, one of the deadliest forms of CHD. Hypoplastic left heart syndrome is the underdevelopment of the left side of the heart, which reduces its ability to pump blood.
The increasing survival rate of children with CHD increases the need for physicians trained to treat them when they become adults, and that need grows as the country’s population ages. is expected to increase further. In 2012, the American Board of Medical Specialties created a subspecialty certification for adult congenital heart disease.
These are just a few of the many innovations in heart care that have saved countless lives.
“Recent advances in the diagnosis and treatment of heart disease and related conditions have not only improved the quality of care,” said David J. Skorton, M.D., cardiologist and president and chief executive officer of the Association of American Medical Colleges. said. “We also extended life-saving care to more people by making the procedure less invasive and risky.”
