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Edis Sierra and Shammy.
UAMS Performs State’s First Minimally Invasive Treatment for Life-Threatening Tricuspid Regurgitation
| LITTLE ROCK — The University of Arkansas for Medical Sciences (UAMS) has performed the first minimally invasive treatment for severe tricuspid regurgitation (a leaky heart valve) in Arkansas, offering lifesaving hope for patients who are not candidates for open-heart surgery.
The EVOQUE Tricuspid Valve Replacement System allows a replacement tricuspid valve to be delivered to the heart through a catheter that is inserted into a vein in the groin. Until it received FDA approval in February 2024, the only option for replacing the valve was open-heart surgery, which many patients with the life-threatening condition cannot survive.
After obtaining FDA approval, Edwards Lifesciences in Irvine, California, began introducing the system in just 70 hospitals across the country, including UAMS.
For Edis Sierra, 53, of Danville, the availability of the revolutionary procedure at UAMS was a godsend.
After undergoing surgery in 2018 at another hospital to replace a different heart valve — her mitral valve — she began losing energy, gaining weight and experiencing aching joints and massive swelling in her legs and abdomen. Eventually, she also experienced jaundiced eyes, frequent nosebleeds, and blue-tinged fingertips and lower limbs.
Her primary care physician, suspecting underlying liver and kidney problems, referred her to the UAMS Division of Gastroenterology and Hepatology, where kidney and liver experts determined that the problem did not originate within the kidneys or liver. Division chief Mauricio Garcia, M.D., referred her to Michael Luna, M.D., chief of the Structural Heart Program at UAMS.
Luna, a nationally recognized leader in structural and congenital heart disease, traced the problem to fluid retention caused by a severely leaky tricuspid valve. The fluid had been building up for some time, placing a tremendous strain on Sierra’s organs.
Luna said often physicians don’t recognize that the symptoms Sierra was experiencing can stem from a severely leaky tricuspid valve, especially when the patient is obese, which makes it difficult to spot the problem on internal images, and when the patient has gone untreated for a long time.
Luna said he knew that Sierra needed a new tricuspid valve, but because of the damage to her liver and kidneys, she was unlikely to survive open-heart surgery.
Fortunately, he also knew that Edwards Lifesciences was seeking FDA approval for its EVOQUE system, the first-ever minimally invasive alternative to replacing a tricuspid valve. He immediately began lobbying to let UAMS be one of the first institutions to offer the procedure, and to let Sierra be one of the first patients to benefit from it, after it received FDA approval. Meanwhile, he began working with Sierra to improve her health, to ensure that she would qualify for the procedure.
One requirement was that she lose weight. Sierra said that when she first saw Luna in April 2024, she weighed 315 pounds — 100 pounds above her normal weight — because of the accumulated fluid.
Although she was able to get down to 270 pounds by November 2024, her fluid retention remained excessive, prompting Luna to hospitalize her temporarily. Then in February, her husband and daughter found her standing in a closet at home in a confused state.
Emely Sierra said her mother was admitted to another hospital, where she remained in an “altered state” for four days. While Edis Sierra was hospitalized, Luna called to say she had qualified, at long last, for the Evoque procedure at UAMS. Luna then arranged for her transfer to UAMS to prepare her for EVOQUE implantation.
“It was God’s timing,” Emely Sierra said. “We really believe it, because before we saw Dr. Luna in 2024, they thought she was just gaining weight, and they wanted to put her on a weight-reducing drug.”
Finally, after several days of aggressive treatment, Edis Sierra was ready to undergo the valve replacement procedure on March 5.
The procedure requires only a one-night hospital stay and is done with the patient under general anesthesia.
Luna said the procedure went very well. Using a catheter that he inserted into a vein in the groin, he was able to deliver a new EVOQUE tricuspid valve into the heart, guided by multimodality imaging.
Tricuspid valve regurgitation occurs when the valve between the two right heart chambers doesn’t close tightly, allowing blood to leak backward into the upper right heart chamber. This creates less blood flow to the lungs and makes the heart work harder to pump blood. One cause of the condition is rheumatic fever, which Edis Sierra said she had as a child.
The EVOQUE valve is designed to self-expand once in place, and then seal within the native tricuspid annulus, secured by nine ventricular anchors.
Luna said it provided “dramatic” relief for Sierra.
“It helped her immensely,” Emely Sierra agreed. “She had been so weak, and her hand was cold, and her lips were purple. Now her fingertips and lips were pink, her nosebleeds stopped, and she was feeling stronger.”
Five months later, Edis Sierra’s lab results show that her kidneys and liver are continuing to function correctly, and that her heart is pumping the way it’s supposed to. Meanwhile, her weight has dropped to 215, and she is undergoing cardiac therapy that includes an hour of physical exercise in the morning.
“It has been years since she was able to do that,” her daughter said.
Edis Sierra said she is also happy to get back to one of her favorite activities, playing with her dog Shammy, a Sheltie. She said Shammy used to eagerly wait for her to toss a ball to him but stopped when she became too tired to play.
“Now he’s always waiting for me again,” she said.