New Heart Valve Procedure Unique to Region Offers Patients a Less Invasive Path to Better Health

Burlington, VT – Hazel Winter, 82, lives for her dog, Gracie. But as she aged, she found most other daily activities increasingly difficult. Plagued by fibromyalgia – a disorder characterized by pain, fatigue, sleep, memory and mood issues – she found herself frequently in pain and experiencing debilitating shortness of breath. 

“I put it down to me being a former smoker and old age,” says Winter, who lives in Williston, Vermont. “But in hindsight, I just wasn’t listening to my body.”

A minor stroke sent her to the Emergency Department at University of Vermont Medical Center, where clinicians discovered a problem with her heart. An echocardiogram revealed tricuspid valve regurgitation, a condition where the valve allows blood to leak backward into the heart. The condition causes fatigue, swelling in the legs, shortness of breath, irregular heart rhythms and, in severe cases, heart failure. Older patients like Winter are at particular risk.

A person’s chance of heart valve disease increases significantly with age, according to the National Institutes of Health, and a significant number of older patients with severe conditions go untreated due to the risks of conventional surgical procedures. Now, an innovative, minimally invasive procedure offered at UVM Medical Center is reducing the risk patients face, dramatically improving their quality of life and speeding their return to life outside the hospital. 

In the past, patients like Winter have been faced with a fraught decision: elect to undergo open-heart surgery, or live with a condition that reduces their quality of life. Instead, she became one of the first patients in the region to undergo Tricuspid Transcatheter Edge-to-Edge Repair (TEER), where surgeons use a clip to repair the leaky valve.

The procedure, available through the region’s only academic medical center, UVM Medical Center, brings leading-edge cardiac care to patients throughout region served by University of Vermont Health Network, a rural academic medical system serving Vermont and northern New York.

“Not long ago, there weren’t many treatment options for folks like Hazel who struggle with a leaky tricuspid valve,” says Cara Ladouceur, RN, a cardiology nurse at UVM Medical Center. “Open-heart surgery is feasible, but comes with more risk, especially for people of advanced age.”

“I’ll tell you right now, if [surgery] was my only option, I would’ve said no and just lived with this condition,” says Winter. “But it wouldn’t have been much of a life.”  

UVM Medical Center is the only Vermont hospital to offer the procedure and is one of the leading centers in the region for TEER. At a time when the region’s population is aging, the new procedure is helping to keep leading-edge cardiac care closer to home and reducing the need for medical travel to cardiac centers in places like Boston and New York City. 

 “I arrived by wheelchair, and I’m planning on walking out of here today,” Winter said from her hospital bed, less than 24 hours after her procedure. “I can’t believe the difference this has made for me already. It’s a game changer.”

Higher Quality of Life and Shorter Recovery Times

The TEER procedure involves a small clip that is guided to the heart through small incisions in the patient’s groin. Interventional cardiologists like Rony Lahoud, MD, use thin, flexible tubes known as catheters to position the clip, which then attaches to the valve and reduces leakage.

“This is opening up a whole new set of options for people like Hazel who struggle to live a full life,” says Dr. Lahoud. “To watch people go home the very next day and immediately feel a difference - that’s the kind of outcome you aspire to have.”

A 2023 study found TEER to be safe and highly effective, reducing severe regurgitation to mild or moderate in about 90% of patients and significantly improving their quality of life. Compared to conventional surgery, TEER also offers shorter recovery times. Winter was back home with Gracie within 24 hours and noticed an immediate improvement in her condition.

“I’m a little sore, but this has already made an amazing difference,” says Winter in between Gracie snuggles. “There were a lot of pains and problems that I chalked up to my fibromyalgia and old age that are now just gone. I feel like a person again.”

Keeping Leading-Edge Care Local for a Historically Undertreated Condition

When Dr. Lahoud first met Winter, he had already helped hundreds of people with faulty heart valves go on to enjoy longer, healthier lives. He is part of the structural heart team at UVM Medical Center, a group of clinicians advancing heart valve treatment through cardiac catheterization, a minimally invasive procedure used to diagnose and repair or replace ailing heart valves.

Using a catheter to repair or replace a heart valve is a recent breakthrough in international cardiology. At first, it was a procedure reserved largely for patients deemed high risk for surgery and struggling with a faulty aortic valve, the most commonly treated heart valve disease. 

“That marked the birth of our structural cardiology program, led by my colleague, Dr. Harold Dauerman, says Dr. Lahoud. “Since 2012, our patients and hospital have become part of the remarkable journey of developing and adopting transcatheter technologies,” he says. “Today, UVM Medical Center’s structural heart team replaces more than 325 aortic heart valves each year using the novel transcatheter aortic valve replacement procedure, while gaining invaluable experience treating other valves in the heart.” 

Nicknamed the “forgotten valve,” the tricuspid valve has historically been under-treated due to its more complex anatomy and its location deep inside the heart’s right chamber. Approximately 1.6 million Americans have tricuspid valve regurgitation, according to the National Institutes of Health.

Last year, Dr. Lahoud and his interventional cardiology partner Tanush Gupta, MD, along with advanced imaging cardiologists Trace Barrett, MD, and Peter VanBuren, MD, performed the first tricuspid TEER at UVM Medical Center. Winter was the fifth person to undergo the procedure, and several more individuals benefitted from TEER in subsequent weeks. Dr. Lahoud expects the tricuspid TEER program to grow to serve more patients in Vermont and northern New York, cementing an innovative treatment option locally for a historically difficult-to-treat form of heart valve disease. 

 “Pushing the boundaries of what is possible requires true collaboration between different specialties, including interventional cardiology, advanced cardiac imaging, cardiac anesthesia and cardiothoracic surgery, among others,” says Dr. Lahoud. “We are fortunate to have the prerequisite talent right here in Vermont to continue to grow a high-quality structural cardiology program.”