- What is the Mitral Valve?
- What is Mitral Regurgitation or Insufficiency?
- How is Mitral Regurgitation Treated?
- What are Mitral Valve Repair Techniques?
- What are Minimally-Invasive Approaches to Mitral Valve Repair?
- What is Robotic Mitral Valve Repair?
- What is "Mini-Mitral" Valve Repair?
The mitral valve is a one-way valve that conducts blood flow through the left side of the heart. When open, the mitral valve permits oxygenated blood from the lungs to fill the heart’s main pumping chamber, the left ventricle. When the left ventricle squeezes to deliver blood throughout the body, the mitral valve normally closes to prevent blood from flowing back toward the lungs.
Mitral regurgitation or insufficiency is a condition whereby the mitral valve permits blood from the left ventricle to leak back towards the lungs. Mitral regurgitation is most often caused by congenital malformation or damage due to trauma, infection, or heart failure. Depending on the severity of the leakage, this situation can lead to progressive lung congestion and heart failure. Symptoms commonly include shortness of breath, decreased exercise endurance, and swelling of the extremities.
The severity of mitral insufficiency can sometimes be reduced with medications, however the most definitive treatment involves surgical repair of the valve or replacement with a prosthetic valve.
In many cases, the mitral valve can be repaired by reconstructing the native valve tissues to restore normal valvular structure and function. Experimental and clinical research has shown that repair of the mitral valve is preferable to its replacement largely because native mitral valve is an intimately associated with the structure of the left ventricle. In cases when repair of the mitral valve cannot be performed successfully, mitral valve replacement is another option. Mitral valve replacement involves removing much of the native mitral valve tissues and replacing it with an artificial valve consisting of animal and/or manufactured components. For either operation, the most common surgical approach to the mitral valve requires the surgeon to saw open the breastbone and spread the edges apart to gain direct access to the heart.
Although this approach provides excellent access to the heart, the resulting wound requires several months to heal completely, an extended recovery period with substantial activity restrictions, and can be subject to serious complications including infection, breakdown, and even death.
Posterior Quadrangular Resection for Posterior Mitral Leaflet Prolapse
Alfieri Edge-to-Edge Repair for Bileaflet Mitral Prolapse
Simple Annuloplasty for Central Mitral Regurgitation (Carpentier Type I)
Recently, new less invasive approaches for mitral valve surgery have been developed centered upon accessing the valve through much smaller incisions and without cutting the breastbone. These minimally-invasive operations are performed with the use of specialized hand-held instruments or a robotic device. There is mounting evidence to suggest that, compared to patients undergoing standard open-chest cardiac operations, these minimally-invasive approaches translate into
- less pain
- better wound cosmesis
- fewer wound complications
- shorter hospital stays
- shorter recovery time
Robotic-assisted surgery for mitral valve repair is now available at The Johns Hopkins Hospital. Mitral valve repair is one of the first cardiac surgical operations performed with a robotic-assisted system and for which FDA approval was obtained. Pioneered in Europe and further refined in the United States, repair of leaking mitral valves due to myxomatous disease, chordal rupture, or annular dilatation, exploits the technical advantages robotic-assisted surgery provides. The mitral valve can be accessed by a small 6 to 8 cm right thoracotomy and two 1 cm instrument ports. Excellent visualization of the mitral valve with the robotic camera system is usually obtained, greatly facilitating its repair. Posterior quadrangular resections and/or "sliding-plasty" repairs are generally performed.
If you are a patient with isolated mitral insufficiency who would like to be evaluated for this minimally invasive approach to mitral valve repair, ask your doctor for a referral to The Johns Hopkins Hospital. If you are a doctor and would like to discuss or refer a patient who may be a good candidate for robot-assisted mitral valve repair, please feel free to contact our offices directly at (410) 955-9780.
In this approach, the mitral valve is approached through a small 3” incision made between the ribs on the right side of the chest. Specialized hand-held instruments are used to work on the mitral valve through this small incision. Although the ribs are gently spread, no bone is actually cut and the breastbone is left intact. This approach still requires use of the heart-lung machine which is connected to the circulation through a 1”-2” incision made in the right groin crease. Many recent studies have confirmed that, performed correctly by qualified surgeons, this approach is safe with short- and long-term results that are comparable to those of standard approaches. In fact, significantly shorter recovery times and lower wound complication rates have been observed with this minimally-invasive approach.
In most cases, hospital stays average between three and four days after minimally-invasive mitral valve repairs compared to six or more days with standard approaches. Most patients who undergo standard chest-splitting cardiac operations are restricted from activities including lifting, sports involving arm involvement, and driving for six to 8 weeks. In comparison, patients undergoing minimally-invasive operations are free to engage in any of these activities as early as one to two weeks after surgery.