Open-heart surgery alternative: What one device can do for high-risk patients

Open-heart surgery has traditionally been the standard for repairing leaking mitral or tricuspid valves, but it involves considerable risks and a long recovery.

Older adults are often ruled out as candidates due to being considered too high-risk; however, for these patients, Transcatheter Edge-to-Edge Repair (TEER) provides a potential, less invasive alternative with a quicker recovery.

In New Zealand, access to TEER is severely restricted in the public system, leaving many high-risk patients without treatment options.

Dr Andrew Chatfield, a consultant in Coronary and Structural Interventional Cardiology and a member of the Cardiac Advisory Board at Kia Manawanui Trust – The Heart of Aotearoa (now the Cardiac and Respiratory Foundation) believes TEER is a revolutionary procedure for treating mitral valve regurgitation.

Mitral valve regurgitation is a common but serious condition that if, left untreated, can lead to severe complications, including heart failure and death.

Mitral regurgitation (MR) occurs when the mitral valve fails to close properly, causing blood to leak backward and forcing the heart to work harder.

Around 2-5% of the population, and 8% of people over 75, are affected.

The symptoms, shortness of breath, fatigue, and a reduced ability to perform daily tasks, can progress to pulmonary oedema, heart failure and eventually death if left untreated.

Open-heart surgery is the usual treatment for severe MR, but many high-risk patients cannot undergo it.

In New Zealand, nearly 50% of patients with MR are not offered surgery, particularly those over 75 with additional health issues such as kidney or lung disease.

For these patients, the outlook is poor, with worsening quality of life, repeated hospitalisations, and increased risk of stroke.

Without intervention, MR can reduce life expectancy more than many malignant cancers, with half of severe MR patients over 75 dying within five years.

TEER offers these patients a lifeline.

For those considered “too high risk” for surgery, the only alternative is palliative care.

“For these people, TEER can be lifesaving,” Dr Chatfield says.

Globally, more than 300,000 patients have benefited from TEER.

Research shows that TEER reduces repeat hospital admissions by up to 60 percent, frees up intensive-care beds, and dramatically improves quality of life.

Patients are typically discharged the next day – a stark contrast to the week-long hospital stays and months-long recoveries that follow open-heart surgery.

New Zealand is lagging behind, Dr Chatfield says.

“Internationally, TEER is the standard of care for patients with significant mitral regurgitation who are at high surgical risk.

“It’s publicly funded in places like Canada and Australia, but here it’s largely confined to the private sector or a few compassionate cases in the public system,” he says.

“We have the technology, we have the expertise, and we have patients who desperately need it. What’s missing is public funding.”

During his fellowship in Vancouver, Dr Chatfield performed structural heart procedures on a weekly basis, including regular TEER cases.

In Wellington, however, he has not been able to perform a single TEER, despite identifying many suitable patients upon his return to New Zealand.

The latest 2025 guidelines from the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery, emphasises early intervention with TEER for patients with mitral regurgitation.

Right now, TEER isn't funded by the Ministry of Health in New Zealand.

Some TEER devices are already available in New Zealand for high-risk patients, yet without government support, access remains limited to those who can pay privately.

"This leaves us in a position of telling some of our most vulnerable patients that they either need to risk open-heart surgery or go without,” Dr Chatfield says.

Patients in New Zealand deserve access to TEER, he says.

“It’s time we brought our standards in line with the rest of the world.”

New Zealand’s failure to fund TEER isn’t just medically outdated – it’s economically irrational, he says.

“The cost of repeated hospital stays, ambulance transfers, and long rehabilitation far outweighs the cost of the procedure itself.

“When you look at the big picture, funding TEER is not just the compassionate choice – it's a financially sensible one.”