46 Patient Questions Answered by Dr. Marc Gillinov!
Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Marc Gillinov, MD, Chairman of Cardiac Surgery, Cleveland Clinic
Published: September 5, 2024
Wonderful!
During our recent patient webinar, “3 Questions to Ask Before Mitral Valve Surgery”, I received 46 questions that we did not have time to answer during the live event. That said, Dr. Marc Gillinov, who is the Chairman of Cardiac Surgery at the Cleveland Clinic and the featured speaker of the webinar, typed up answers to each patient question to help educate our patient community.
Question #1: Michael asks, “I already have a TAVR and now need a TMVR. I do have a ring in the mitral valve that was installed in 2005 both the valve and the ring are Edwards Lifesciences products. It’s a flexible and complete ring. What should I know?”
If the mitral valve ring is flexible, TMVR is not possible. — Dr. Marc Gillinov
Question #2: Deena asks, “If a severely calcified MV repair was successful, what is the “probability” it will continue to calcify and require another repair?”
Very unlikely. — Dr. Marc Gillinov
Question #3: Laura asks, “I had a mitral valve repair by Dr. Gillinov in 2019 with a ring. Will I always need to take antibiotic prior to dental procedures. How about 81 mg ASA? Thank you. I am listening to this because my 22 year old daughter has moderate regurgitation. I pray she never needs surgery.”
Yes. Antibiotics with dental and take aspirin. — Dr. Marc Gillinov
Question #4: Jan asks, “My mitral valve will need repair due to regurgiation. I have a pig value and 5 stents. Most recently had a carotid-carotid bypass w/prosthetic, carotid subclavian transposition and a zone O TBE. can a mitral be done without open procedure in today’s world? Eco in three weeks to check on things.”
May be possible with a MitraClip. — Dr. Marc Gillinov
Question #5: Michael asks, “I had rheumatic fever as child. Will the disease also have a significant effect on the left side valves?”
Usually not. — Dr. Marc Gillinov
Question #6: Prabhjot asks, “If a patient has a mitral stenosis and already performed a Balloon Valvuloplasty twice what is the chances of getting it done again. Age is 31 with no other complications?”
Would get surgical placement of a new valve. — Dr. Marc Gillinov
Question #7: George asks, “I had mitral valve repaired at the Cleveland clinic in 2013 and had to go back and get a replacement pig valve in 2017 and currently no noticeable issues. How long do the valves (pig) last ? I am 66.”
Usually around 10 years. — Dr. Marc Gillinov
Question #8: Anonymous asks, “Can you explain how grading of valve regurgitation works?”
Easiest grading system is 0-4, with 4 being severe regurgitation. — Dr. Marc Gillinov
Question #9: Suzi asks, “Can a person who is a hemophilia carrier be on blood thinner for a mechanical mitral valve replacement?”
Would not recommend that. — Dr. Marc Gillinov
Question #10: John asks, “Have we made any progress in the past year in repairing rheumatic mitral valves. My wife is a patient of Dr. Unai and we have been watch and wait stable but she will need both an aortic and mitral replacement or repair eventually.”
Most of the time, replacement is better in this setting. — Dr. Marc Gillinov
Question #11: Robin asks, “Should one take antibiotics if have mitral value leak before have teeth cleaned and if so what antibiotics?”
Only if you have had surgery. — Dr. Marc Gillinov
Question #12: John asks, “Can my wife only have the mitral replaced or repaired if the aortic valve is bad but maybe not bad enough to risk a dual valve surgery?”
Better to fix everything that is broken. — Dr. Marc Gillinov
Question #13: Michael asks, “How does afib impact decision making for mitral valve repair and replacement?”
Favor repair and adding a biatrial maze procedure. — Dr. Marc Gillinov
Question #14: Paul asks, “I had robotic mitral valve repair surgery 10 years ago…. Does that effect my other valves over time? My aortic root is measuring 4.0 in my most recent echocardiogram. It seems to have worsened almost every year. My cardiologist tells me to not worry about it, but it’s always on my mind.”
Mitral valve repair does not affect the aorta or aortic valve. Your aorta is very unlikely to reach 5 cm, which is the size of an aneurysm. — Dr. Marc Gillinov
Question #15: John asks, “Would my 45-year-old, thin, otherwise healthy wife be a candidate for minimally invasive mitral valve surgery? If so, can a repair be done with robotic surgery?”
Likely yes, but need appropriate preoperative screening with CT scan and coronary angiogram. — Dr. Marc Gillinov
Question #16: Kam asks, “For mitral valve repair can you discuss pros / cons of robotic vs. mini-thoracotomy using direct vision.”
With the robot, better visualization and smaller incisions. But the mini-thoracotomy is also a very good approach in experienced hands. — Dr. Marc Gillinov
Question #17: George asks, “When do you know when it is time for a replacement of your mitral valve?”
Primarily based upon the echocardiogram, in combination with your clinical status and symptoms. — Dr. Marc Gillinov
Question #18: Kathy asks, “Do I need to come back to Cleveland after I have completed successful surgery? It has been three years since my surgery and I go to a major Los Angeles hospital now for care? I had to have a pacemaker put in after my surgery in Cleveland. But am doing fine. Should I still check into Cleveland in person?”
We’d be happy to see you, but as long as you are getting a good echo annually, there is no compelling need to return to see us. — Dr. Marc Gillinov
Question #19: Allen asks, “For a patient with posterior leaflet prolapse with flail do you generally perform a sliding repair over the triangular resection technique?”
The sliding repair is a variant of resection used to reduce the height/amount of leaflet. I perform about 50% of resections with a sliding repair and 50% as simple triangular resections. I tailor it to the patient’s valve. — Dr. Marc Gillinov
Question #20: Anonymous asks, “Hi, After surgery we are told to take antibiotics before dental cleanings and procedures. What is the way the plaque and other bad stuff enter your body, is it by swallowing or through the bloodstream by the dental instruments making your gums bleed? Is there a difference in risk depending on procedure such as tooth removal or cleaning?”
Bacteria can enter through the gums with any dental procedure. After a mitral valve repair, I would take antibiotics before any dental procedure. — Dr. Marc Gillinov
Question #21: Bridget asks, “Mitral valve repair at 60 years of age. Pig skin. If my valve last 10-20 years what can I expect for my next surgery. Invasive. Open heart. Thank you.”
It may be possible to place a new biological valve through the femoral vein–the vein in your leg. — Dr. Marc Gillinov
Question #22: Cindy asks, “Well and why does no one tell you the grade? I ask like crazy trying to understand and thanks SO much for saying that!!!”
I want every patient to know everything about themselves, so I go over all tests performed, from the blood tests to the echo and CT scan, and explain everything. — Dr. Marc Gillinov
Question #23: George asks, “How does ejection fraction compare to the 1 through 5 scale?”
Ejection fraction is graded from 0% to 70%. It is a measure of the left ventricle’s contractility or squeezing power. A normal ejection fraction is 50%-55%. With a severely leaking mitral valve, a normal ejection fraction is 65%. — Dr. Marc Gillinov
Question #24: Michael asks, “What is your opinion on the clip procedure for repairing the mitral valve?”
It works well in selected patients. We are doing an NIH-sponsored trial comparing the clip to surgery, and this will give us some good data. Right now, in the US, the clip is approved for mitral valve repair in patients who are at very high or prohibitive risk or very high risk for surgery. — Dr. Marc Gillinov
Question #25: Judy asks, “Can two mitral valve repairs be done back to back or must you always get a valve replacement after the repair starts to fail?”
If a repair has failed, we can re-repair about 70%. It depends on the findings at surgery and the surgeon’s level of experience. Re-repair is the best option when feasible. — Dr. Marc Gillinov
Question #26: Bonnie asks, “Are women more under-diagnosed than men with asymptomatic mitral valve prolapse? None of my primaries thought I should see a cardiologist, yet when I finally did she & I were both shocked to find out I have severe mitral valve regurgitation.”
I do not think that women are more under-diagnosed, but it is certainly possible. I’m glad that your doctor heard your murmur. It can be difficult to hear these murmurs with a stethoscope. You have a good cardiologist. — Dr. Marc Gillinov
Question #27: Stephanie asks, “I have anterior leaflet problem. Can that be repaired?”
Anterior leaflet prolapse is more challenging to repair than posterior leaflet prolapse. However, experienced surgeons can repair a valve with anterior leaflet prolapse more than 95% of the time. — Dr. Marc Gillinov
Question #28: Jo asks, “I have significant bileaflet mitral prolapse. Can this be repaired?”
98% repair rate for bileaflet prolapse. — Dr. Marc Gillinov
Question #29: MJ asks, “Should any degree of prolapse have a repair? Even if there is just mild regurgitation? You mentioned prolapse is another name for myxomatous disease. So repair is indicated for this also? I thought you said this may never progress at this low level?”
Prolapse = Degenerative disease = Myxomatous disease. The valve should only be repaired if the leak is significant, meaning it is 3 or more on a scale from 0-4. — Dr. Marc Gillinov
Question #30: Anonymous Attendee asks, “Are patients who have Vascular Ehlers Danlos (vEDS) also operated on for mitral valve repair versus replacement?”
Yes. — Dr. Marc Gillinov
Question #31: Dan asks, “I’m also a successful and VERY grateful 2015 mitral valve repair patient of Dr Gillinov. My question is, ‘How important are pre-antibiotics before dental procedures after MV repair surgery? Is it a serious issue if this doesn’t happen?”
I would take antibiotics before all dental procedures if I had previous mitral valve repair. An occasional miss will usually not be significant. — Dr. Marc Gillinov
Question #32: Robin asks, “How recent does the CT Scan have to be?”
Within 6 months as a screening tool before robotic mitral valve surgery. — Dr. Marc Gillinov
Question #33: Eric asks, “77 Year old active male with no significant comorbidities and no MAC noted. A2 flail with probable chordae rupture and mild P2 prolapse on TEE with anterior eccentric jet and moderate MR. Post mild non-STEMI MI in 2014 with non astomosed LIMA graft. Cath demonstrates only 30-40 coronary artery”irregularities”. TTE demonstrates LVEF 40-50%. Normal size LV with mild left side irregularities.”
Consider surgical repair. — Dr. Marc Gillinov
Question #34: Bridget asks, “What is the best tool to show calcium in the arteries? My cath showed no calcium build up signs but I had a heart scan with a result of 80.”
Cath is the definitive test to determine the status of the coronary arteries and the extent to which there are important lesions/blockages. — Dr. Marc Gillinov
Question #35: Stephanie asks, “Does Dr. Gillinov do valve repair with sternotomy or thoracotomy (ie: not using the robot)?”
Yes, we offer all approaches to the valve and choose the approach that is safest for each individual patient. Safety is by far the most important consideration. — Dr. Marc Gillinov
Question #36: Eric asks, “Any reason why sternotomy with replacement trumps minithoracotomy and repair. Or even sternotomy with chordae repair?”
Most important to repair the valve if possible. The specific chest wall approach influences recovery time, but the first priority is a safe valve repair. — Dr. Marc Gillinov
Question #37: Eric asks, “Is Mitraclip a viable approach with ruptured chordae and A2 flail and mild P2 prolapse?”
It might be. It depends on the very specific anatomy. — Dr. Marc Gillinov
Question #38: Michael asks, “What about replacement of mitral valve? I had replacement 10 years ago. Can you do it robotically?”
Yes we can replace certain mitral valves robotically. — Dr. Marc Gillinov
Question #39: Heather asks, “Can you speak at all to what you would recommend for someone who has a Cosgrove Ring and has been recommended for that ring to be replaced?”
It sounds like you need a reoperation for a failed mitral valve repair. In most instances of reoperation, we do remove the previous ring and then work to re-repair the valve, if feasible. — Dr. Marc Gillinov
Question #40: Anonymous asks, “If you need an aortic valve reoperation and have a leaking mitral valve, I assume that you should have a sternotomy and fix them both at the same time.”
Yes.– Dr. Marc Gillinov
Question #41: Ann asks, “I have Pulmonary Hypertension, caused by congenital heart failure. Had heart cath last Sept and rt heart numbers were better in November. Last echo done 2 yrs ago. Next one to be done in October. Pulmonary Hypertension not being treated.”
There are few specific treatments for pulmonary hypertension. If it is caused/worsened by a leaking mitral valve, fixing the valve can help. — Dr. Marc Gillinov
Question #42: Karen asks, “Do patients often develop SVT a few years post mitral valve repair? Is it likely related to the previous surgery or just a new heart anomaly?”
Likely a new finding. Atrial fibrillation can occur as we get older. — Dr. Marc Gillinov
Question #43: Anonymous asks, “I am Dr.Gillinov’s patient. Got a robotic mitral valve repair two years back for regurgitation at Cleveland Clinic. Question: 1) How long do you continue to take Metoprolol. 2) Do you have to control salt, oil and other food intake even after few years of surgery 3) Also once in a while you see heart rate going up or down, is it normal. Thank you!?”
Unless there is a specific indication (e.g. high blood pressure), there is no need to continue metoprolol. There is no specific diet for the repaired valve. — Dr. Marc Gillinov
Question #44: Selene asks, “How long will a tissue valve for aortic valve replacement last?”
Generally 10+ years. — Dr. Marc Gillinov
Question #45: Jim asks, “Thank you Dr. G for all that you do! I had Mitral Valve Repair surgery recently and unfortunately had to have a cardio version to get heart beating normal again & then developed Heart Block within a month afterwards & now have a pacemaker. I’m extremely thankful for a successful repair surgery, but just wanted to ask you how common it is for patients to need a pacemaker after Mitral Valve Repair surgery & wanted to get your best guess as to why this may happen?”
After a mitral valve repair, approximately 1-2% of people will need a new pacemaker. It can be related to treatment of atrial fibrillation, which can occur after heart surgery. — Dr. Marc Gillinov
Question #46: Christina asks, “My son Dr. Siewe is scheduled for MV robotic sx mid of next month at the Cleveland clinic. I hope to see Dr. Gillinov next month during or after the procedure.”
I look forward to meeting you. — Dr. Marc Gillinov
Many Thanks Dr. Marc Gillinov!
I have to extend a mighty “THANK YOU” to Dr. Marc Gillinov for taking the time to answer the patient questions submitted during our special webinar, “3 Questions to Ask Before Mitral Valve Surgery”.
Keep on tickin!
Adam
Written by Adam Pick
- Patient & Website Founder
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