First successful “valve-in-MAC” transcatheter mitral valve replacement in Louisville region

Innovative application of device intended for treatment of aortic valve disease used for successful transcatheter replacement of native mitral valve, improving patient’s quality of life

A multidisciplinary team of interventional cardiologists and a cardiothoracic surgeon performed Louisville’s first successful transcatheter replacement of a native mitral valve this week. The team with Norton Heart & Vascular Institute Structural Heart Program used a transcatheter aortic valve (commonly referred to as TAVR) to replace the patient’s mitral valve that was unable to be treated with standard techniques.

“While this procedure has been described as very rare, when it can be done, it is lifesaving and changes the trajectory of the patient’s life,” said Daniel P. Rothschild, M.D., interventional cardiologist, Norton Heart & Vascular Institute, and lead operator of the case. “Being able to achieve this outcome for our patient is remarkable.”

Severe mitral annular calcification (MAC) can make standard treatment options such as open heart surgical valve replacement prohibitive. Advanced CT imaging performed by the Structural Heart Program’s imaging specialists identified the patient’s valve characteristics as ideal for the valve-in-MAC procedure. Using the TAVR device, the surgical team positioned the valve in the heart through a catheter placed in the patient’s leg. The replacement valve was then deployed by balloon inflation and anchored itself to the native valve’s calcium. The approach is minimally invasive and the patient was able to work with physical therapists the following day.

“There are many elements that make this procedure unique,” said D. Sean Stewart, M.D., interventional cardiologist, Norton Heart & Vascular Institute and director of the Structural Heart Program team. “Factors such as the size, shape and amount of calcification of the mitral valve all play a critical role in making this procedure feasible.”

The patient remains under observation by the Structural Heart Program team and is continuing to improve.

This is a unique opportunity to provide this patient with a treatment that would improve their quality of life,” said David H. Rosenbaum, M.D., cardiothoracic surgeon, Norton Heart & Vascular Institute and member of the Structural Heart Program team. “While people won’t know they need this specific type of multidisciplinary care, they can rest assured the team at Norton Heart & Vascular Institute has the experience to perform these difficult and rare cases.”

The Norton Heart & Vascular Institute Structural Heart Program brings together cardiothoracic surgeons, interventional cardiologists and imaging cardiologists to provide patients with a high level of care and treatment. Through Norton Heart & Vascular Institute, patients are fast-tracked for evaluation, diagnosis and treatment conveniently on the Norton Audubon Hospital campus, Louisville’s only Heart Center of Excellence hospital.


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