Duke Health Performs the World’s First Living Mitral Valve Replacement
The innovation occurred after a unique confluence of circumstances, saving the lives of three girls
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DURHAM, N.C. – A team at Duke Health was able to perform the world’s first living mitral valve replacement after an adolescent girl received a full heart transplant and donated the healthy valves from her original heart.
The valves were then used to save the lives of two other girls; one of whom received the new procedure. All three girls who were part of the case are from different parts of North Carolina.
The current standard of care for pediatric heart valve replacement uses preserved non-living tissue or mechanical valves, which do not grow along with the child. As a result, recipients require multiple future valve replacement surgeries and blood thinners for mechanical valves, which both carry risks.
“There's not a good valve option for kids,” said Douglas Overbey, M.D., assistant professor in the Department of Surgery at Duke University School of Medicine and one of the team members behind the pioneering procedure.
“They all require multiple surgeries, and we know they're going to fail down the road,” Overbey said. “That's something that's really hard to talk to parents about, knowing that you're going to have to do the same surgery with a new valve, maybe six months later because they're going to outgrow it.”
The first living mitral valve replacement was performed on 14-year-old Margaret Van Bruggen, from Charlotte. She received the valve from 11-year-old Journi Kelly, from Wilson, after Journi received a full-heart transplant. Journi also donated another valve to now 9-year-old, Kensley Frizzell from Pembroke.
The living mitral valve replacement is a type of partial heart transplant, which Duke pioneered in 2022. Partial heart transplant was studied in Duke research labs before the procedure was done, and research shows the living valves do continue to grow. Duke has now performed 20 partial heart transplants under the guidance of the FDA.
The idea behind partial heart transplant is to make use of the healthy valves from donated hearts. The procedure expands the number of lives that benefit from a limited number of donated hearts and has enabled domino heart transplant procedures, in which valves are used from a failing heart after it’s removed for transplant.
“To think that the lives of three girls could be saved after one full-heart donation is amazing,” said Joseph Turek, M.D., Ph.D., Duke’s chief of pediatric cardiac surgery, who performed the procedure alongside a vast team, after research in the lab.
Doctors at Duke said the living mitral valve replacement was challenging due to the valve’s position and structure, and it carries risks commonly associated with heart surgery. The mitral valve is located inside and toward the back of the heart, making it difficult to access. Its parachute-like structure with various chords and muscle grouping makes it more difficult to suture in.
The procedure became a possibility in a unique confluence of circumstances, starting with Journi, who went into sudden heart failure and needed a transplant.
The youngster complained of a stomachache, but when her parents took her to the emergency room, they learned her heart was failing. Two days later she was transported by aircraft to Duke for transplant, where she waited on the list for a new heart.
“Before Journi’s surgery, we were told the doctors were hoping to try a new procedure and asked if we were willing to donate Journi’s old heart,” said Rachel Kelly, Journi’s stepmom. “They explained to us that they could use the healthy parts of it to help other kids. Our next question was, ‘Where do we sign?’”
As a donated heart became available for Journi, the valves from her original heart were serendipitously a match for both Margaret and Kensley. Margaret, a cross-country runner and high school freshman, needed the valve replacement suddenly and urgently after she contracted a bacterial infection (endocarditis) that created large holes in her mitral valve.
“She was in the hospital, and we could’ve lost her,” said Margaret’s mother, Elizabeth Van Bruggen. “But she was so brave, so I knew I had to be brave too. She’s got a lot left to give the world.”
Kensley’s family was excited to hear it may be the last surgery she could need. The 9-year-old is familiar with long hospital stays, having already experienced her first two operations before her first two months of life after being diagnosed with a genetic disorder called Turner’s syndrome.
“We were expecting she would need surgery, but we never knew this would be an option,” said Kenan Frizzell, Kensley’s father. “The whole situation is extraordinary, whether you look at it from the standpoint of a scientific breakthrough or the average person’s point of view. I can’t imagine all the coordination that’s needed for something like this to take place, but as one of the families that benefited, we can’t be anything other than grateful.”
Research leading to the surgical innovation was supported by the Brett Boyer Foundation and the Graeme McDaniel Foundation.