Mitral Valve Surgery

maryp: my mother has been diagnosed with severe mitral regurg. and is interested in robotic surgery, what are her options?

Speaker_-_Dr__Mihaljevic: The robotic surgery is a valuable option even for elderly patients. The operation can be performed with minimal risk.

Speaker_-_Dr__Mihaljevic: A final decision is always made after a careful review of the records. We would be more than happy to review your mother's records.

peter59: what is the probability of reoperation for mitral valve repair on the 48 yr old?

Speaker_-_Dr__Mihaljevic: Mitral valve repair can be performed even after a failed earlier attempt to repair the valve. Repeated operations on a mitral valve can be accomplished robotically in some cases and with the very low risk.

Speaker_-_Dr__Mihaljevic: Patients who get their mitral valve repaired in their 40s are most likely going to enjoy a lifelong benefit from surgery. The failure rate from the operation is only 10 to 15% over 20 to 25 year period.

michael48: What about a person who has MVP with regurgitation and slightly enlarged LA as well as a history of Atrial Fibrillation treated with Sotolol, a MV Repair has been suggested by the cardiologist with a Maze Procedure to control the arrhythmia.

Speaker_-_Dr__Mihaljevic: I would definitely agree with the recommendation since the enlargement of the LA and the presence of atrial fibrillation are suggestive of an advance stage of the disease.

Speaker_-_Dr__Mihaljevic: Mitral valve repair and a maze procedure can be done in the same setting using robotically assisted approach.

doncarrera: How many CT surgeons in the Cleveland-Pittsburgh-Columbus area can perform the MI mitral valve repair?

Speaker_-_Dr__Mihaljevic: I am not really certain about exact number of surgeons who perform this procedure, however, you look at centers who provide both minimally invasive options and mitral valve repair options. Look at the volume and outcomes of those procedures. You can compare our statistics to other hospitals - look at our website for those numbers.

namaste1: My daughter had open heart surgery when she was 1 yr old. Tetralogy of Fallot. She is 20 now and one of her valves is leaking. Her surgeon wants to wait before fixing the valve to see if it can be done robotically, but not sure how that works.

Speaker_-_Dr__Mihaljevic: The repair of mitral valves for congenital heart disease can often be complex and whether we can repair her valve using robotic instruments would require a careful review of her medical records.

Speaker_-_Dr__Mihaljevic: Heart surgery should not be done at the same setting of reconstructive surgery.

peter59: During the surgery, they said that mitral valve repair was better than mitral valve replacement, why?

Speaker_-_Dr__Mihaljevic: Because the repaired mitral valve perform better over short and long term than the artificial heart valves. Keeping your own valve reduces the risk of potential life-threatening complications (such as a stroke) that are often associated with artificial heart valves.

mary: They mentioned the ring is very important to a valve repair surgery. If I am looking for valve repair surgery, should I make sure they also include a ring in my surgery

Speaker_-_Dr__Mihaljevic: Absolutely. The purpose of the ring is to prevent the later deterioration of the function of the mitral valve.

Trudy: eleven years ago I had a double by-pass surgery and the TE report shows some aortic valve mild regurgitation and mild tricuspid valve shows some mild regurgitation pulmonary valve N/D and mitral valve regurgitation moderately severe, could this be corrected during the same operation? And verify that the by-passes are still in good working condition? And if not, replace them at the same time?

Speaker_-_Dr__Mihaljevic: The answer is yes provided that the severity of leakage through the mitral valve truly warrants surgery. Patients who had bypass surgery in the past may have mild to moderate leakage through the mitral valve - but that does not pose the need for surgery.

Speaker_-_Dr__Mihaljevic: Before you get to surgery, you would need a detailed echocardiogram and most likely a repeated cardiac catheterization to assess the condition of your previous bypasses.

michael48: Does a history of AF and PVs with moderate to severe mitral regurgitation complicate the surgery outcome.

Speaker_-_Dr__Mihaljevic: This is a common observation in patients who have mitral regurgitation. Atrial fibrillation can be treated successfully by doing a Maze procedure at the same time as doing a mitral valve repair.

liswife: What would cause "heart failure" after robotic mitral valve repair. Prior to surgery ejection rate of 60 after surgery rate of 35?

Speaker_-_Dr__Mihaljevic: This is a very good question because decline in ejection fraction after mitral valve repair is actually very common and an expected finding.

Speaker_-_Dr__Mihaljevic: The decline in ejection fraction does not implicate a decline in heart function. Patients with severe leakage of the mitral valve have falsely elevated ejection fraction prior to the surgery. So that the repair of the mitral valve eliminates this false impression and unmasks and reveals a true ejection fraction which is often times lower.

michael48: Do you find that patients with chronic controlled AF who have the repair see correction of the AF from the repair alone or do they find that the Maze needs to be done no matter what?

Speaker_-_Dr__Mihaljevic: In those patients, maze needs to be done in conjunction with mitral valve repair. Mitral valve in isolation is not a cure for atrial fibrillation.

hillm: If a patient had breast cancer , mastectomy with radiation to the chest , and now has mitral valve issues. Would robotics still be an option?

Speaker_-_Dr__Mihaljevic: Absolutely. Robotics may be especially attractive solution to patients who had previous radiation to the chest because of a lesser chance of wound infection when using a small incision on the side of the chest instead of a sternotomy, which is division of the breast bone.

Aortic Valve Surgery

bimals77: Dr., I am 30 year old. I have an aortic leaky valve my dr told me I have to do surgery I don't want put artificial valve, please suggest me what should I do?

Speaker_-_Dr__Mihaljevic: You should send us your records for evaluation**. As a 30 year old, you are certainly a candidate for minimally invasive aortic valve repair, so that valve replacement may not be necessary.

Speaker_-_Dr__Mihaljevic: Send us the records for review. The optimal mode of treatment will be made after careful review of your medical records. This type of surgery is done with a minimal risk.

markd: how and when would i know that I am a good candidate for aortic valve surgery? How do i find a doctor?

Speaker_-_Dr__Mihaljevic: That depends on the type and severity of aortic valve disease. Most patients have aortic stenosis (which is a narrowing of the aortic valve). Timing of the surgery is mostly determined by echocardiogram an ultrasound of the heart, which accurately determines the severity of disease.

bimals77: I am 30 years old , i have sever aortic leaky valve, i want play soccer,i want get married, do whatever want. what would be the best option?

Speaker_-_Dr__Mihaljevic: Leaky aortic valves can often times be repaired using a minimally invasive approach. Repairs are usually performed at specialized centers and can be done with a minimal risk and excellent long term results.

Speaker_-_Dr__Mihaljevic: If the aortic valve repair is accomplished patients can resume all regular activities of daily life, including getting married.

Trudy: I am an 80 year old male with Aortic Stenosis and mitral valve regurgitation and I want to know if they both can be repaired at the same time.

Speaker_-_Dr__Mihaljevic: Patients with aortic stenosis and mitral valve regurgitation usually require replacement of the aortic valve and a repair of the mitral valve. This operation can be done using a minimally invasive approach at the same time.

bimals77: Aortic valve repair Is this life time solution for leaky valve for 30 year old male ?

Speaker_-_Dr__Mihaljevic: It is a potential lifetime solution for patient whom aortic valve repair can be performed. Based on your age, I would assume you would have a bicuspid aortic valve, which means that your aortic valve is made out of two cusps instead of three. If that is the case, you have a 70% chance for successful repair of your valve using a minimally invasive approach (however without a robot).

Tricuspid Valve Surgery

jbbrown: I need tricuspid valve repair or replacement due to radiation received 24 years ago to left breast. Would I be a candidate for robotic surgery?

Speaker_-_Dr__Mihaljevic: Tricuspid regurgitation after chest radiation is a difficult problem to solve. although you may qualify for robotic surgery you will need to be carefully evaluated prior to operation to insure the optimal mode of operation.

Myxoma

katie: I have been diagnosed with myxoma, is robotic surgery an option?

Speaker_-_Dr__Mihaljevic: Yes it is. Robotic surgery is an excellent option for removal of myxoma, which is a benign growth in the heart.