Re: Mitral Valve Surgery

Posted By No. VA Patient on October 01, 1998 at 15:44:38:

In Reply to: Re: Mitral Valve Surgery posted by CCF CARDIO MD-APS on October 01, 1998 at 10:42:38:






I am a 50 year old male with MVP and moderate regurgitation, and live in
the northern Virginia suburbs of Washington DC.  I have been reading
in the forum about the two ways that MVP is surgically corrected
(repair or replacement), if needed.  I have also noted that there is minimally
invasive procedure for such surgery.  
My questions are these: 1) Who developed the minimally invasive
procedure, and where? 2) Does the minimally invasive procedure carry any
more/less risk? 3) Is the minimally invasive procedure common enough
that I should be able to find a qualified and experienced doctor in the
northern Virginia area to perform such a procedure? 4) Can the
minimally invasive procedure be used regardless of whether the mitral
valve is repaired or replaced?  and 5)  How long can one expect a mitral
valve repair to last compared to a mitral valve replacement?
Any information you can provide will be greatly appreciated.
                                 Thanks, Fred



__


: Dear Fred,
1.The minimally invasive surgical repair and replacement of the mitral valve was for the most part developed right here at the Cleveland Clinic Foundation by our own chairman of cardiovascular surgery, Dr.D.Cosgrove.
2.There is not an increased risk per say in the surgeon experienced in this fairly new technique; the surgery was designed for a smaller incision that would be more cosmetic and would require less recovery time-both of which are for the most part very true.  Some surgeons feel strongly that the body is less taxed by the smaller incision than the conventional down the middle of the sternum incision.
3.The procedure is not that common except at very well trained and prepared centers such as this one, for your closest possibilities, look into Duke U. Hospital-specifically Dr.Donald Glauer, and inquire at the Wahington Hospital Center.  Your best bet is to ask the surgeons at these centers how many such surgeries they have performed in the last year and how many of their repair attempts end up as replacements.
4.Minimally invasive repair and replacement are both performed, as a matter of fact, most surgeons go in with an attempt at repair and if it doesn't look good (still leaking,etc.), then they will convert to a replacement-usually only after their BEST attempts at a repair.
5.The longevity of a mitral valve repair is dependent on quite a few factors in regards to the individual patient, for instance the state of the left ventricle at the time of surgery, and the extent of residual regurgitation after the repair.  
  Certainly the repair is unlikely to last nearly as long as say a mechanical prosthesis(St.Jude valve), but there has been recent evidence suggesting that your heart overall, especially the left ventricle will definitely do better with a repair.  This is definitely something to discuss with
  the surgeon before the surgery so that you are in agreement regarding long term expectations.  Some patients opt for replacement because they can not stand the thought of a likely future re-do surgery, but then you are on coumadin, a blood thinner for the rest of your life-and there is no guarentee that
  you will not need another prosthetic valve in the distant future.  YOu see it is very complicated and the decision needs to be very well thought out.  Good Luck.  
Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment can only be made by your physician(s).


No. VA reference: Dr. Robert Albus, Fairfax Hospital does minimally invasive mitral valve repairs.