Dr. Saibal Kar talks about performing the first procedure of inserting Abbott’s next generation version (FDA approved July 2018) of the company’s leading MitraClip® heart valve repair device in the U.S.
Dr. Saibal Kar is a cardiologist in Los Angeles, California and is affiliated with multiple hospitals in the area, including Cedars-Sinai Medical Center and Ronald Reagan UCLA Medical Center. He received his medical degree from NRS Medical College Calcutta and has been in practice for more than 20 years. Dr. Kar accepts several types of health insurance, listed below. He is one of 177 doctors at Cedars-Sinai Medical Center and one of 161 at Ronald Reagan UCLA Medical Center who specialize in Cardiology.
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, glad that you could join us. Our guest today is Dr. Saibal Kar, he’s Director of Interventional Cardiac Research at the Smidt Heart Institute at Cedars-Sinai in Los Angeles and he’s joining us on the program today to talk about mitral regurgitation and also about how he has performed the first procedure of inserting Abbott’s next-generation version of the MitraClip® heart valve repair device here in the United States. Welcome to the program Dr. Kar.
Dr. Saibal Kar: Thank You Howard and room good morning.
Neal: Well you are a cardiologist, was cardiology your first love in medical school or did something personal happened to steer you in that direction?
Dr. Kar: Well it was my first … in medicine and I was to some extent steered by my father who was a famous cardiologist in India so I did from a very early age get interested in the heart and that’s what led me to become a cardiologist.
Neal: What is mitral regurgitation and how is it diagnosed?
Dr. Kar: In the body there actually are four heart valves and the two most important heart valves are the aortic valve and the mitral valve on the left side. And the mitral valve, what it does is that it prevents blood from the lower chamber to go back to the upper chamber and allows blood to flow from the lower chamber to the main vessels of the body and allowing blood to flow. What happens is that mitral regurgitation is one of the commonest heart valve problems and when it starts to leak, blood goes backward into the upper chamber increasing the pressure in the lungs and the patients become very short of breath, very fatigued and if it’s left untreated, patients can be short of breath, very fatigued, they get admitted in the hospital several times from heart failure and ultimately succumb to this if not treated.
Neal: So how is this condition treated?
Dr. Kar: Well the standard way of treating the patients with severe mitral regurgitation is open heart surgery but some patients because of their age or other comorbid conditions or frailty cannot have open heart surgery. And so one such approach for treating people who cannot have open heart surgery is using this MitraClip® which is owned by Abbott Vascular. It’s a very elegant system where the procedure is done in a laboratory under x-ray and echo guidance and on a beating heart and this catheter is threaded through a small vessel into the groin up to the heart and while the heart is still beating we can actually capture the leaflets where’s leaking the most, reduce the leakage and change the symptoms of the patients instantaneously. Patients usually stay in the hospital just one day and go home the next morning without any incision on the chest.
Neal: Now normally what would a hospital stay be like? A week or a couple of weeks?
Dr. Kar: Well if you have open-heart surgery in a patient who’s not complicated, usually seven days. But if it’s a complicated procedure or the patient is very sick, they can go up two weeks and month. This patient even in the sickest patients they hardly stay more than two days and not even in the ICU.
Neal: They can basically go home and with very minimal care and supervision, begin the road to recovery very very quickly?
Dr. Kar: Exactly, that’s right.
Neal: As you said these patients that have other comorbid conditions and are not candidates for this type of MitraClip® procedure, are they candidates for any type of treatment or is open heart surgery their last best hope and we hope that they recover?
Dr. Kar: So you’re right, so we have patients as you say they’re low surgical risk patient and their anatomy is suitable then they undergo open-heart surgery and then you have a category of patients which are at high surgical risk and the anatomy is suitable for the clip they undergo the clip procedure. But the third category is what you were concerned about, say a patient has a leaking valve and he’s hired for surgery and then the clip may not work – the options that we can do are either just medical treatment as palliation, we can try a high-risk open a surgery or sometimes we can actually try the clip procedure and not necessarily eliminate the leakage but at least you reduce it. And if we can reduce it, that may be good enough for the patient. And that goes to our topic today, that MitraClip® second generation, actually this is the third generation which has been just used in the United States allows us to treat some of these patients which we couldn’t do before.
Neal: You personally have performed this procedure here in the United States for the first time. Is that correct?
Dr. Kar: That’s correct on 6 30 2018 actually I did the first procedure.
Neal: So you’re basically waiting to see exactly how well your brand new patient fares in the recovery process.
Dr. Kar: Right. Since the approval in the United States I’ve done already about 15 to 20 patients and there are several patients have already done around the United States. I happen to be the core principal investigator of a registry called the … Registry which is prospectively going to analyze these patients treated with this new version the MitraClip® in the U.S. and Europe and we are collecting data to see how this new clip system improves outcomes compared to the previous generation.
Neal: As far as availability and the cost of this new procedure, how does it fare against the second and first generation MitraClip® developed by Abbott?
Dr. Kar: So at the present moment the new version of the MitraClip® is available in selected centers in the United States and they’re slowly expanding it to more centers in the U.S. I don’t know the exact number of centers, we’re just starting it but hopefully by the next few months it’s going to be available all around the U.S. but Abbott is being very careful in their rollout and they’re gradually rolling it out to experienced centers to make sure that there’s no untoward effects. The cost of the procedure is exactly the same as the previous version of the MitraClip®.
Neal: Where can where our listeners go online and get some more information about the MitraClip® and more about Abbott as well?
Dr. Kar: So if you actually go to the website, there’s a lot of websites on mitraclip.com itself or you can go on www.vascular.abbott you can actually see that. And the other option is that in centers like us in the West Coast like Cedars-Sinai you can actually go to our website on the Smidt Heart Institute at www.cedars-sinai.org and you can find out more about the procedure, the availability, how to get appointments, how to get treated.
Neal: Thank you for joining us this morning Dr. Saibal Kar, Director of Interventional Cardiac Research at the Smidt Heart Institute at Cedars-Sinai. It’s been a pleasure speaking with you.
Dr. Kar: Thank you Howard.
Neal: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. Transcripts and audio of this program are available at hpr.fm and healthprofessionalradio.com.au. Be sure and subscribe to the podcast on iTunes, listen in and download at SoundCloud and visit our Affiliate Page at hpr.fm