A Structural Heart Program is a specialized medical center focused on diagnosing and treating defects in the heart’s structure, including the valves, chambers, and major blood vessels. These programs address conditions that are distinct from coronary artery disease, which involves blocked arteries that supply blood to the heart muscle. Structural heart disease encompasses a range of non-coronary issues that require highly specialized expertise and often advanced, minimally invasive treatments. The development of these programs reflects a major shift in cardiology toward catheter-based solutions for problems once exclusively managed with traditional open-heart surgery.
Defining the Structural Heart Program
Structural Heart Programs provide comprehensive care for complex heart anatomy issues. Their focus involves selecting the most appropriate treatment pathway for each patient, increasingly leaning toward less invasive, catheter-based interventions. The goal is to repair or replace damaged structures without the need for a large incision to open the chest cavity. This approach minimizes recovery time and reduces the physical stress on patients, many of whom are older or have multiple co-existing health conditions.
The program utilizes sophisticated diagnostic and imaging technologies to visualize the heart’s three-dimensional structure with precision. Advanced imaging, such as transesophageal echocardiography and cardiac computed tomography (CT), is performed before, during, and after procedures to guide the interventional specialists. This detailed visualization is the foundation for successful minimally invasive procedures, allowing for accurate device placement and sizing. The program’s setting is typically a hybrid operating room or a dedicated catheterization laboratory, equipped with surgical capabilities should an unforeseen complication arise.
Conditions Treated by Structural Heart Programs
Structural heart programs address pathologies that affect the heart’s function through mechanical defects rather than electrical or arterial blockages. A significant portion of the patient population presents with valvular heart disease, where one or more of the heart’s four valves fail to open or close correctly. One common condition is aortic stenosis, a progressive, degenerative disease where calcification causes the aortic valve leaflets to stiffen and narrow the outflow tract from the left ventricle, impeding blood flow to the body. This increased resistance causes the heart muscle to thicken, which can ultimately lead to heart failure symptoms.
Another frequently treated valvular issue is mitral regurgitation, which occurs when the mitral valve does not close completely, allowing blood to leak backward into the left atrium during the heart’s contraction phase. Regurgitation can be classified as primary (degenerative, due to leaflet damage) or secondary (functional, due to heart chamber enlargement), and both forms strain the heart and lungs. Structural programs also manage congenital defects, such as a Patent Foramen Ovale (PFO) or an Atrial Septal Defect (ASD), which are holes in the wall separating the heart’s upper chambers. These defects can permit abnormal blood flow or allow clots to pass from the venous system to the brain, risking stroke.
Left Atrial Appendage Occlusion (LAAO) is a procedure designed to reduce stroke risk in patients with non-valvular atrial fibrillation who cannot tolerate long-term blood thinners. The left atrial appendage is a small, pouch-like structure where over 90% of stroke-causing blood clots form in this patient group. By closing or sealing this appendage, the program aims to prevent clot formation and subsequent embolization without relying on oral anticoagulant medication.
Key Interventional Procedures
The core of structural heart programs lies in the sophisticated, catheter-based procedures that offer alternatives to open-chest surgery. Transcatheter Aortic Valve Replacement (TAVR) is the leading intervention for severe aortic stenosis, involving the deployment of a new, collapsible bioprosthetic valve within the diseased native valve. This new valve is delivered via a catheter, typically inserted through a small incision in the femoral artery, and expanded to immediately restore proper blood flow dynamics. The TAVR procedure replaces the valve without the need to remove the diseased tissue, allowing for rapid recovery times compared to traditional surgery.
For mitral regurgitation, Transcatheter Mitral Valve Repair (TMVr) is commonly performed using devices like the MitraClip system. This procedure involves guiding a catheter through the femoral vein and across the wall separating the atria to reach the left side of the heart. The small clip is then used to grasp the edges of the mitral valve leaflets in the area where they are leaking, creating a double-orifice opening that reduces or eliminates the backflow of blood. This technique improves the valve’s coaptation and is particularly beneficial for high-risk patients who would not be candidates for open-heart repair.
Structural defects like PFO and ASD are sealed using specialized closure devices. The closure device, often resembling a small, double-disc umbrella, is delivered via a catheter inserted through a vein in the leg. Once positioned to straddle the defect in the atrial septum, the device is deployed to physically plug the opening, and heart tissue eventually grows over the implant, creating a permanent seal.
The Multidisciplinary Team Approach
Collaboration of a multidisciplinary team, frequently referred to as the “Heart Team,” is essential to a Structural Heart Program. This model ensures that every patient’s complex case is evaluated from multiple perspectives to determine the optimal, individualized treatment plan. The core team includes Interventional Cardiologists, who specialize in catheter-based procedures, and Cardiovascular Surgeons, who provide expertise in open-heart techniques and surgical anatomy. Their combined experience is invaluable, especially when converting a traditionally surgical procedure into a percutaneous one.
Advanced Cardiac Imaging Specialists, such as echocardiographers and cardiac CT specialists, are also integral members, providing the real-time visualization needed to guide the complex device placement. Structural Heart Nurse Coordinators manage the patient journey, coordinating the extensive pre-procedural testing, providing patient education, and ensuring seamless follow-up care. This collaborative structure leverages the unique skill sets of each professional, making complex decision-making and high-risk procedures safer and more effective for patients with diverse structural heart issues.