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Study details safe, effective, minimally invasive mitral valve repair
September 29, 20092-inch incision provides access to repair diseased valve
Surgical treatment for mitral valve disease includes either repairing the patient's diseased valve or replacing it with a metal, mechanical valve or an animal tissue valve. The majority of those procedures are open-heart operations that require a major incision in the chest. Now, after a six-year study, surgeons at the University of Maryland Medical Center in Baltimore conclude that minimally invasive mitral valve repair techniques, through only a two-inch incision in the right side of the chest, are safe, durable and effective. The results are published in the September 2009 Annals of Surgery.
"Our experience with 187 patients demonstrates that small-incision mitral valve surgery can be performed safely and effectively with a short hospital stay and a rapid recovery," says lead author James S. Gammie, M.D., a cardiac surgeon at the University of Maryland Medical Center and associate professor of surgery at the University of Maryland School of Medicine.
The most common complications from mitral valve surgery are stroke, kidney failure and infections, none of which occurred among the 187 consecutive patients who received the minimally invasive procedure at the University of Maryland Medical Center, beginning in 2003. Echocardiograms taken just prior to discharge, which were read by cardiologists who did not know the method of mitral repair or surgical approach, showed that 99 percent of the repaired valves were working properly. The median hospital stay was four days. All patients survived the surgery and 2½ years later, 99 percent of the patients were still alive.
Mitral valve surgery was first performed in 1960, when surgeons replaced the diseased, native valve with an artificial valve. For the next 20 years, replacement with a metal or animal tissue valve was the gold standard. Dr. Gammie says no device is as good as a patient's own valve. The metal valve tends to form blood clots, which can lead to a stroke, so patients must take a blood-thinning medication for the rest of their lives, with the risk of bleeding. The tissue valves are less likely to cause clots, but they last only 10-15 years. However, patients with a repaired valve can expect it to last for the rest of their lives.
Rates of mitral valve repair compared to valve replacement vary widely by institution and by surgeon. The repair rate among patients in this study was 96.7 percent for all small-incision mitral valve procedures and 100 percent for patients with mitral valve regurgitation (leakage of blood through the valve). This is well above the current national average of 60 percent repair for all mitral valve operations and 70 percent with procedures to correct pure mitral valve regurgitation.
While there has been widespread adoption of minimally invasive, patient-friendly techniques is most areas of surgery, there has been little data to prompt the routine use of these techniques in mitral valve surgery, especially in cases where the valve can be repaired.
"The small-incision approach fits with our emphasis on mitral valve repair rather than replacement," says the study's senior author, Bartley P. Griffith, M.D., chief of Cardiac Surgery at the University of Maryland Medical Center and professor of surgery and head of the Division of Cardiac Surgery at the University of Maryland School of Medicine. "We prefer to fix a broken mitral valve rather than replace it, because a repair lasts longer and rarely requires another operation down the road."
The study was conducted between May 2003 and March 2009. The mean age of patients was 53.6 years and 64 percent of the patients were male. "The minimally invasive approach is not usually applicable for patients who are markedly obese, elderly or who have significantly reduced cardiac pumping function, or those who require aortic valve or coronary artery bypass grafting along with mitral valve surgery," says Dr. Gammie.
The minimally invasive mitral valve repair takes, on average, just over 2½ hours to complete. The heart is stopped during the operation for just over an hour, a relatively short time for complex heart surgery, according to Dr. Gammie.
He adds that because this surgery is more technically demanding than an open-heart repair, "We are uncertain if this approach is appropriate for hospitals that only occasionally perform mitral valve surgery or for surgeons who have not yet had a lot of experience with mitral valve repair," says Dr. Gammie.
"This minimally invasive approach to mitral valve repair exemplifies the commitment of our faculty physicians to provide the best care for their patients," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine. "Very few surgeons across the United States perform this complex, small-incision procedure, yet the long term benefit to patients is unquestionably superior to valve replacement."
The mitral valve (named after the miter, a distinctive cap that bishops wear) is the "inflow valve" for the left ventricle, the main pumping chamber of the heart. Blood flows from the lungs, where it picks up oxygen, across the open mitral valve and into the left ventricle. When the heart squeezes, the two leaflets of the mitral valve snap shut and prevent blood from backing up to the lungs. Blood is directed out of the heart to the rest of the body through another valve, the aortic valve.
University of Maryland Medical Center
The most common complications from mitral valve surgery are stroke, kidney failure and infections, none of which occurred among the 187 consecutive patients who received the minimally invasive procedure at the University of Maryland Medical Center, beginning in 2003. Echocardiograms taken just prior to discharge, which were read by cardiologists who did not know the method of mitral repair or surgical approach, showed that 99 percent of the repaired valves were working properly. The median hospital stay was four days. All patients survived the surgery and 2½ years later, 99 percent of the patients were still alive.
Mitral valve surgery was first performed in 1960, when surgeons replaced the diseased, native valve with an artificial valve. For the next 20 years, replacement with a metal or animal tissue valve was the gold standard. Dr. Gammie says no device is as good as a patient's own valve. The metal valve tends to form blood clots, which can lead to a stroke, so patients must take a blood-thinning medication for the rest of their lives, with the risk of bleeding. The tissue valves are less likely to cause clots, but they last only 10-15 years. However, patients with a repaired valve can expect it to last for the rest of their lives.
Rates of mitral valve repair compared to valve replacement vary widely by institution and by surgeon. The repair rate among patients in this study was 96.7 percent for all small-incision mitral valve procedures and 100 percent for patients with mitral valve regurgitation (leakage of blood through the valve). This is well above the current national average of 60 percent repair for all mitral valve operations and 70 percent with procedures to correct pure mitral valve regurgitation.
While there has been widespread adoption of minimally invasive, patient-friendly techniques is most areas of surgery, there has been little data to prompt the routine use of these techniques in mitral valve surgery, especially in cases where the valve can be repaired.
"The small-incision approach fits with our emphasis on mitral valve repair rather than replacement," says the study's senior author, Bartley P. Griffith, M.D., chief of Cardiac Surgery at the University of Maryland Medical Center and professor of surgery and head of the Division of Cardiac Surgery at the University of Maryland School of Medicine. "We prefer to fix a broken mitral valve rather than replace it, because a repair lasts longer and rarely requires another operation down the road."
The study was conducted between May 2003 and March 2009. The mean age of patients was 53.6 years and 64 percent of the patients were male. "The minimally invasive approach is not usually applicable for patients who are markedly obese, elderly or who have significantly reduced cardiac pumping function, or those who require aortic valve or coronary artery bypass grafting along with mitral valve surgery," says Dr. Gammie.
The minimally invasive mitral valve repair takes, on average, just over 2½ hours to complete. The heart is stopped during the operation for just over an hour, a relatively short time for complex heart surgery, according to Dr. Gammie.
He adds that because this surgery is more technically demanding than an open-heart repair, "We are uncertain if this approach is appropriate for hospitals that only occasionally perform mitral valve surgery or for surgeons who have not yet had a lot of experience with mitral valve repair," says Dr. Gammie.
"This minimally invasive approach to mitral valve repair exemplifies the commitment of our faculty physicians to provide the best care for their patients," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine. "Very few surgeons across the United States perform this complex, small-incision procedure, yet the long term benefit to patients is unquestionably superior to valve replacement."
The mitral valve (named after the miter, a distinctive cap that bishops wear) is the "inflow valve" for the left ventricle, the main pumping chamber of the heart. Blood flows from the lungs, where it picks up oxygen, across the open mitral valve and into the left ventricle. When the heart squeezes, the two leaflets of the mitral valve snap shut and prevent blood from backing up to the lungs. Blood is directed out of the heart to the rest of the body through another valve, the aortic valve.
University of Maryland Medical Center
Mitral Valve Current Events and Mitral Valve News RSSHalf of eligible patients not getting mitral valve surgery, U-M study shows
Overblown fears about surgical risk and lack of awareness about the risk of not operating are among the reasons only half of eligible patients were referred for mitral valve repair, according to a study by doctors at the University of Michigan Cardiovascular Center.
New way to fix leaking mitral heart valves safe in initial testing
A new nonsurgical technique to repair leaking mitral valves in heart failure patients was safe in a study reported in Circulation: Cardiovascular Interventions.
Mount Sinai first in US to implant FDA-cleared ring for mitral valve repair
David H. Adams, MD, Marie-Josée and Henry R. Kravis Professor and Chairman of the Department of Cardiothoracic Surgery at The Mount Sinai Medical Center, performed the first two implantations of the Carpentier-Edwards Physio II ring in the United States yesterday.
Women with Mitral Valve Prolapse are Treated Less Aggressively Than Men and May be at High Risk
Disturbing evidence of higher mortality and lower surgery rates in women versus men with mitral valve prolapse and severe leakage may be related to the complexity of evaluating the condition's severity in women, according to findings of a Mayo Clinic study published this month in the Annals of Internal Medicine.
Should we use echocardiography to screen young athletes?
Sudden and unexpected deaths in young competitive athletes are uncommon but highly visible events, which raise concern and ethical issues in both the lay public and medical community.
UC Davis researchers define characteristics, treatment options for XXYY syndrome
Researchers at the UC Davis M.I.N.D. Institute and The Children's Hospital in Denver have conducted the largest study to date describing the medical and psychological characteristics of a rare genetic disorder in which males have two "X" and two "Y" chromosomes, rather than the normal one of each.
Evalve MitraClip: Clinical trial of nonsurgical repair for severe mitral valve regurgitation
The Cedars-Sinai Heart Institute is the lead enroller in the world for the Everest II Clinical Trial - a study comparing non-surgical repair for severe mitral valve regurgitation with conventional surgery.
Exercise Testing May Help Predict Seriousness of Mitral Regurgitation
In as many as one in five people over age 55, when the heart contracts to send blood around the body, some degree of backward leakage occurs across the mitral valve, a condition known as mitral regurgitation (MR).
New data shows benefits of MitraClip for patients with mitral regurgitation
The vast majority of patients who had a successful result with the percutaneous MitraClip device did not need mitral valve surgery three years after their procedure, and many benefited from significantly improved function of the left ventricle (commonly known as reverse remodeling).
Percutaneous valve therapy: is it safe and effective?
Researchers at TCT 2007, the annual scientific symposium of the Cardiovascular Research Foundation (CRF), will present new studies evaluating a rapidly advancing field within interventional cardiology: percutaneous procedures to repair and replace defective heart valves.
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Atlas of Mitral Valve Repair by Edward B Savage (Author), Steven F Bolling (Author) This full-color atlas with accompanying video DVD provides a complete and practical "how-to" guide to planning and performing mitral valve repair surgery for mitral regurgitation. The book reviews the natural history of mitral regurgitation, the functional anatomy of the mitral valve, and the use of echocardiography in preoperative evaluation and surgical planning. Chapters describe and illustrate all techniques currently used for mitral valve repair and discuss results. A bound-in DVD presents narrated video clips of six cases that show the application of specific techniques. Each case begins with preoperative echocardiograms demonstrating the mitral valve defect and proceeds through key surgical maneuvers. |
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Mitral Valve Prolapse in Thyroid Patients Jim Lowrance (Primary Contributor) |
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Atlas Of Mitral Valve Repair by Lippincott Williams & Wilkins Atlas of Mitral Valve Repair : Atlas of Mitral Valve Repair Pub Date: December 2005 Product Type: Print Author/s: Edward B Savage MD; Steven F Bolling MD This full-color atlas with accompanying video DVD provides a complete and practical /"how-to/" guide to planning and performing mitral valve repair surgery for mitral regurgitation. The book reviews the natural history of mitral regurgitation, the functional anatomy of the mitral valve, and the use of echocardiography in preoperative evaluation and surgical planning. Chapters describe and illustrate all techniques currently used for mitral valve repair and discuss results.A bound-in DVD presents narrated video clips of six cases that show the application of specific techniques. Each case begins with preoperative... |
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Natural Therapies for Mitral Valve Prolapse by Ronald Hoffman (Author) Relief for a condition affecting seven million people. |
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Charlie Rose - Dr. Alain F. Carpentier / Craig Venter (December 25, 2007) A conversation with Dr. Alain F. Carpentier. In 2006, Dr. Carpentier performed an emergency mitral valve repair procedure on Charlie Rose, Charlie fell ill while en route to Damascus to interview Syrian President Bashar al-Assad. || A conversation with Craig Venter, author of A Life Decoded: My Genome: My Life. This product is manufactured on demand using DVD-R recordable media. Amazon.com's standard return policy will apply. |
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Cardiac Auscultation, an Audio Presentation, utilizing The Heart Sound Simulator with accompanying text and illustrations Lower the volume of your phonograph and listen with you stethoscope for realistic heart sounds. Complete set = 136 page book and Twelve (12) 45 records utilizing the Heart Sound Simulator. Records are: 1- Mitral StenosisCardiac 2- Splitting of sounds and second heart sound 3- First heart sound and murmurs (general considerations) 4- Mitral regurgitation 5- Abnormal and extra heart sounds 6- Review Session (1) 7-Aortic valve lesions 8- Congenital heart disease (part 1) 9- Congenital heart disease (part 2) 10- Auscultatory phenomena in other diseases 11- Cardiac arrhythmias 12- Review sessions(2) Ausculltation by Abe Ravin, M.D., F.A.C.C. Associate Clinical Professor of Medicine; University of Colorado School of Medicine. an Audio Presentation utilizing the Heart Sound Simulator with... | |
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The Mitral Valve Prolapse Syndrome/Dysautonomia Survival Guide by James F. Durante (Author), Cheryl L. Durante (Author), John G., M.D. Furiasse (Author), Phillip C., M.D. Watkins (Foreword) Mitral valve prolapse (MVP), a structural flaw in the heart, sometimes causes MVP syndrome, or dysautonomia, an imbalance of the autonomic nervous system. People with this syndrome often experience panic attacks, migraines, irritable bowel conditions, and other symptoms. This book includes sections on nutrition, exercise, and self-help strategies, and explains the illness and provides strategies for living with it. |
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Charlie Rose with Peter Travers & John Lasseter; Vince Vaughn (June 2, 2006) Peter Travers sits down with John Lasseter, the new chief creative director of Disney-Pixar`s combined animation division. As writer, director and producer he has been behind some of the biggest film animated successes of all time including Toy Story I, Toy Story II, Finding Nemo, and The Incredibles. Lasseter talks about his latest project, a film called Cars. Everyone recognized Vince Vaughn's comic talent in 1996`s Swingers. Since then Vaughn has solidified his place as one of the best comic actors with his work in Old School, Dodgeball, Wedding Crashers. Vaughn talks with Peter Travers about his latest project, The Break-Up, which also stars Jennifer Aniston. This product is manufactured on demand using DVD-R recordable media. Amazon.com's standard return policy will apply. |
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Confronting Mitral Valve Prolapse Syndrome by Lyn Frederickson (Author) In the United States alone, over ten million people--many of them women and young adults--are known to suffer from the heart condition known as Mitral Valve Prolapse Syndrome (MVPS). Countless others with chest pains, fatigue, dizziness, depression, migraines, or anxiety attacks are totally unaware that symptoms may be MVPS related or even that MVPS is treatable. |
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