heart valve repair

Posted By  CCF Cardio MD-SGM on March 21, 1998 at 12:15:34:

In Reply to: heart valve repair posted by s scherr on March 13, 1998 at 18:34:07:

: My mother recently had heart surgery to fix a leaky tricuspid and mitral valvle.  The surgeon decided to repair not replace the mitral valve.  Unfortumately, the surgery did not work - a TEE shows that she is leaking at a rate of +3-4.  In addition she is having signs of congestive heart failure. She is 71 and otherwise in fair health.  My questions include: how often do these procedures fail - she had a annuluplasty; how do you tell whn you are a candidate for a second surgical procedure - this was Thanksgiving 97, and how do you find a doctor that specializes in the latest techniques - ie the minimally invasisve procedure - also, how do you know if you are a candidate for this type of procedure.  She had a hard time recovering from the first surgery and if she need a second operation we'd prefer it to be as simple as possible.  thank you..  

[CCF Cardio MD-SGM]

To S. Scherr:
Mitral valve regurgitation(MR) is not infrequently a cause of significant symptoms and functional impairment.  In the last decade, surgical reconstruction(repair) of MR has become the preferred treatment of this problem.  However, not all valves are candidates for repair procedures.   Historically, diseased mitral valves underwent replacement with mechanical (metal) or tissue (bovine or porcine) prostheses.  Although the replacement valves function quite well, they are beset with other problems, including a need for chronic anticoagulation(blood thinning) to prevent clot formation, problems with degeneration and failure of the prostheses, as well as increased risk for infection of the prosthetic material (endocarditis).   The decision on whether to attempt repair of a mitral valve, as opposed to replacement with a prosthesis, involves factors relating to the mechanism of the valve's dysfunction, the degree of calcification, and other factors noted in the pre and intra-operative evaluation of the valve.  As a rule, MR due to rheumatic heart disease is more difficult to repair than MR due to myxomatous disease such as mitral valve prolapse.  
Surgical mortality ranges from 2-6%, approximately, and the success of a repair procedure can vary considerably, depending on the underlying disease and the surgeon's experience with this procedure.  In your mother's case, a recommendation to reoperate in an attempt to correct the persistent MR would be made by an experienced cardiologist and cardiothoracic surgeon.  Another surgery would be more risky than the first, with mortality closer to 10%.   Symptomatic heart failure with severe MR in the presence of good ventricular function and without significant other medical problems would all argue towards repeat surgery.  Medical treatment plays a role here and can improve symptoms considerably.  However, it does not provide a cure for this condition.  
Regrettably, I do not believe that your mother is a candidate for a "minimally invasive" valve surgery due to her recent operation. Patients undergoing repeat cardiac surgery most often require standard midline sternal approaches to provide the best exposure to the heart.  However, an experienced cardiothoracic surgeon would be best fit to make this decision.   If your cardiologist believes that your mother may benefit from a repeat surgical procedure, it would be wise to consult with a large academic/university medical center in order to find the most experienced surgeon, cardiologist, and support personnel.   If you are near Cleveland, we'd be happy to evaluate your mother here at the Cleveland Clinic.  This is the largest center for cardiac valve surgery in the country, with over 1200 valve operations in 1997.  If you wish, make an appointment with Dr. William Stewart or Dr. Mario Garcia at 1800 CCF CARE, Desk F15, in order to be evaluated by a cardiologist.
Best of luck.  Information in the Heart Forum is for general purposes only. Specific diagnoses and therapies can only be provided by your physician.