1st Mitral Conclave Attracts 900 Surgeons… And Me!

When is minimally invasive Mitral Valve repair surgery
going to be the “standard” instead of open heart surgery.

My cardiologist says it is not currently as effective.

Adam, you continue to amaze me. What an honor to be invited to this prestigious event and a well deserved honor. The medical community has embraced you as an integral part of their work and we here on the HVJ will agree.

Hi Adam,
I’m scheduled for mitral valve repair with Dr.Gillinov on July21,
should I maintain,increase or decrease my physical exercise in the interim?
Thank you,
Fred Hugi

As an academic, I’m uncomfortable with what seems to me to be the highly subjective decision mechanism for timing mitral valve replacement. I have serious regurgitation, but both my cardiologist and my surgeon explained that the decision to move forward on repair (probable replacement) surgery is dependent on symptoms. Yikes! (he says to himself). You want ME to decide that I’m more significantly short of breath than I was a few months ago? Suggest a symptom and I’ll have it, lol!!! I’ve enlisted the aid of my wife as careful external observer, who confirms the progress of symptoms. And we’re going ahead with the surgery. But it’s disconcerting that there aren’t some ‘objective’ metrics to push the step past severe regurgitation. Reassurance?

What is the latest thinking on when the mitral valve should be repaired? Is chamber enlargement the real test? Regurgitation volume?

Thanks.

Thanks Adam for including us in this Conclave…..I only ask that you absorb LOTS OF INFO.and tell us what you learned.Because,you are one of us,not a Dr., but a patient.PS….If you happen to see Dr.James Narrod,from Colorado tell him I thank God for his help,8 years+ ago and that I say a prayer that he continues to do the healing work God gave him the tools and intelligence to do. HE IS A MENSCH!!! Keep tickin,thanks Adam ……..Ricky

1. Work from Germany over the last decade appears to show that chordal replacement is at least as effective as resection for posterior leaflet mitral valve repair, yet maintains a more physiological valve structure. The medium term results show excellent durability. Is there a move to use chordal replacement (aka neochordae and gortex-loops) more frequently in the USA? Who are the leading practitioners of this technique in the USA?

2. Atrial fibrillation (Afib) is a frequent occurrence after mitral valve repair surgery in patients with enlarged left atria. Beta blockers or amiodarone are the standard prophylactic treatment, but better therapeutics are needed. What are the latest techniques to prevent Afib after mitral valve repair/replacement surgery?

3. Effective mitral valve repair techniques for myxomatous degeneration have existed for at least the last 30 years (since the groundbreaking work by Carpentier). However, the repairs appear to gradually worsen with time at a rate of ~1-2%/year or more, especially in Barlow’s disease patients, as assessed by increased regurgitation (reoperation rates are still very low). Presumably much of this is due to continued degeneration of the chordae and or leaflets since surgery does not inhibit the underlying disease processes. What surgical/medical techniques are thought best to prophylactically prevent valve deterioration after surgery. Are there any new techniques to solve this problem on the horizon?

Dear Adam,

If you were to have AVR surgery here in New York. Who would you select as a surgeon to guard over your life?

God Bless the work you do,

Joseph

SR, my cardiologist said my biggest danger is heart enlargement, not necessarily regurgitation but, both combined is not good. I asked my surgeon (Irving Kron, UVA Hospital) and cardiologist (Kenneth Sternburg) about robotic and the mitraclip vs sternotomy open heart. Dr. Kron still recommends mini sternotomy (3″ breastbone incision) over the other 2. The mitraclip is for older or patients that can’t withstand the sternotomy surgery. I am having mitral valve repair on May 19th, 2011 via mini sternotomy. If things go as planned, Dr. Kron says I will be in ICU about 24 hours, then go home after 3-5 more days in the hospital. I still think an improved mitraclip would be a great alternative. Results have been very good with it.

For Heart Valve Replacement does that mean open heart surgery? and which is the best choice for replacement? Pig/Cow/or ten man??
Thank U!

Joyce, my cardiologist told me that a mechanical valve would last me all my life but I would have to take the blood thinner named coumadin. My cardiologist tells me this is a pretty nasty drug. The pig or cow’s valve would last 10-20 years, 15 years average then something would have to be done to the valve again. I am going to tell the surgeon before surgery to use a pig valve as this seems to be the most popular and I won’t have to take coumadin the rest of my life.

My husband had a mechanical aortic valve replacement along with an ascending aortic replacement, two years ago.

Is it normal to have an irregular heart rate when drinking regular coffee or alcohol. Are there any concerns in this situation. He is on coumadin

I am 77 years young and have mitral regurgitation and Atrial fibrillation but otherwise I am in good health. I have been advised not to have surgery for my mitral valve problem because of my age. Would you agree?

Someone asked “when is it time to undergo surgery?”

You can be symptomatic but fully functioning in your daily activities. Any good cardiologist cannot determine when it’s going to happen, as it’s becomes a matter of art, not science. You don’t want to ‘push’ it either, you run the risk of damaging the affected valve beyond repair, stretching the heart tissue because of dilation, and worst of all bacterial infection which then your options are limited and time.
Don’t let yourself get to the point that you can’t walk 10 feet without needing a break or not being able to hold your head up
A stress test can determine the extent or functionability of your heart. Regardless, a cath test will be done prior to surgery and the data gathered tells the story. Intrusive but necessary pre-surgery

I feel very uneasy about the subjective nature of criteria and timing of mitral valve surgery. I have moderate to severe regurgitation and would like to get it fixed sooner than later, but I am told that it is not time yet. I do have some symptoms including reduced aerobic capacity which I thought was due to age and palpitations at nite for which I was given beta blocker. I fear that by the time I get noticeable symptoms or the ventricle size changes enough to show up on the 2D doppler echo, there might be irreversible damage. At the same time, I am grateful that I was diagnosed and am being monitored.

I would like to find out about how broke chordae tendineae in the mitral valve are repaired. Any informaiton would be greatly appreciated.