The gold standard for treating mitral insufficiency is mitral valve repair. While many repairs will last during the patient’s lifetime, a certain percentage fail over time. A 2019 Journal of Clinical Medicine study reported the recurrence of mitral valve regurgitation after repair as 5% at five years and an average of 9.6% at ten years. Mitral valve regurgitation, a leaky heart valve, is evidence of repair failure.

There are different options for repairing a mitral valve, including a surgical incision through the sternum, minimally invasive robotic repair, and a transcatheter approach, each with its own benefits and risks. But, are these therapeutic approaches appropriate for mitral valve re-repair?

We received a patient question on this subject from Cindy, who wrote, “My open-heart mitral valve repair from seven years ago is failing. Can a robotic mitral valve surgery be used to re-repair a mitral valve?” During a recent visit to her office, I asked Dr. Joanna Chikwe, Founding Chair of Cardiac Surgery at Cedar-Sinai Medical Center her expert opinion on Cindy’s question.

Key Learnings About Robotic Surgery For Mitral Valve Re-Repair

Here are four important insights from Dr. Chikwe about mitral valve re-operations using a robot:

• It’s important to consider the details of the current repair. “Let’s talk about re-repair first,” said Dr. Chikwe. “The ability to re-repair your valve in a way that’s going to last you a lifetime completely depends on how the repair was done the first time around and why it’s failed.”
• Depending on the defect of the failing mitral valve repair, a mitral valve replacement may be the patient’s best option. According to Dr. Chikwe, there could be a 50/50 chance the valve will need to be replaced rather than repaired with an animal tissue valve (a cow valve or a pig valve) or a mechanical valve.

• Determine the safest re-repair approach. “Can we do it robotically? That completely depends on what other surgery was done,” said Dr. Chikwe. “ Generally, our approach is not to do mitral re-repairs robotically for a number of technical reasons. We think the safest option is just to go through a small incision in the middle of the chest.”
• Robotic mitral clip re-repair success. “I think where a robot is great in a second-time surgery setting is if the first-time surgery was a clip,” Dr. Chikwe said. “We actually have very good experience at re-repairing failed mitral clips robotically, and then if the valve wasn’t touched and the surgery was something else. We’ve done a number of robotic and hybrid approaches for patients who’ve had previous aortic or bypass surgery that now need a mitral repair.”

Thank you, Dr. Chikwe and Cedar-Sinai Medical Center!

On behalf of Cindy and the entire HeartValveSurgery.com community, thank you, Dr. Chikwe, for your expert insight into robotic surgery for mitral valve re-opearations. We’d also like to thank the team at Cedar-Sinai Medical Center for taking great care of our heart valve patients!

Related Links:

• Patient Story: Leila Gets Robotic Mitral Valve Repair 
• Robotic Mitral Valve Surgery Explained by Dr. Joanna Chikwe
• Surgical Mitral Valve Repair: The “Gold Standard” for Mitral Regurgitation

Keep on tickin!
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, I have provided a written transcript of this interview below.