Mitral Valve Repair Less Risky Than Replacement

By  //  December 27, 2013

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SOLUTION TO CONGESTIVE HEART FAILURE

Doctors with Health First Medical Group have proudly served the Space Coast Community for more than 25 years. We make selecting a doctor easy by offering highly qualified physicians and healthcare professionals for your primary care needs as well as a comprehensive network of specialists.

Doctors with Health First Medical Group have proudly served the Space Coast Community for more than 25 years. We make selecting a doctor easy by offering highly qualified physicians and healthcare professionals for your primary care needs as well as a comprehensive network of specialists.

BREVARD COUNTY, FLORIDA – For many years, Patsy Hothan struggled to make it through the day.

“I couldn’t do anything,” said Hothan. “I would barely walk across a room. My quality of life just was not there.”

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MVR MITRAL VALVE REPAIR SPECIALIST: Board certified in general and thoracic surgery, Dr. Gregory Simmons (above right), an expert in mitral valve surgery, is also experienced in the treatment of complex atrial arrhythmias such as chronic atrial fibrillation. A Cocoa Beach resident for 17 years, Dr. Simmons is married and has three daughters who grew up on the Space Coast. He is a staunch supporter of the American Heart Association, has been a member of the American Medical Association and the Society of Thoracic Surgeons and the American College of Surgeons.

Since she was 18, the 72-year-old Titusville resident had been plagued with heart issues, including a mitral valve prolapse and irregular heartbeat. At age 40, she suffered a stroke and since then her life primarily consisted of extended hospital stays and taking many, many medications.

In February of this year, however, Hothan’s life changed for the better, thanks to the mitral valve repair (MVR) surgery performed by cardiovascular thoracic surgeon Dr. Gregory Simmons of Health First Medical Group.

“I went from being 25 percent operational to 100 percent,” said Hothan.

MVR can seem a miraculous procedure to patients who, like Hothan, have been struggling for years.

MITRAL VALVE ANATOMY & PATHOLOGY

The mitral valve, critical to the proper functioning of the heart, serves as the gate from the left atrium – where blood oxygenated by the lungs is collected – to the left ventricle, the powerhouse chamber responsible for pumping blood to the entire body.

Patsy Hothan

PATSY HOTHAN’s life changed for the better, thanks to the mitral valve repair (MVR) surgery performed by thoracic surgeon Dr. Gregory Simmons of Health First Medical Group. “I went from being 25 percent operational to 100 percent,” she said. (Image by Keith Betterley)

In the mitral valve, two flaps called leaflets open and close to maintain proper blood flow, while the annulus, a thick band of tissue at the base of the valve, provides the solid foundation for the leaflets. The cord-like chordae tendinae, hold the leaflets in place and are attached to papillary muscles.

Should the connection between chordae and papillary muscles fail, the leaflets will not close properly, resulting in mitral regurgitation, or backward blood flow. Mitral valve issues include stenosis, or narrowing of the valve opening, which decreases the amount of blood flow, and regurgitation.

With mitral valve regurgitation, blood flows backward into the blood vessels of the lungs. The heart tries to compensate in the short term, but eventually high blood pressure in the arteries of the lungs will appear, leading to severe shortness of breath, fatigue and, ultimately, possible congestive heart failure.

“Mitro valve disease is very prevalent in our society and the occurrence of it increases with age,” said Simmons.

The root of the problem may be congenital or caused by infections, rheumatic fever, heart attacks or just age. More than two percent of the population suffers from mitral regurgitation, an equal opportunity problem that similarly affects men and women.

“It should be emphasized that patients should have treatment before the heart function deteriorates to achieve better long-term outcomes and reduce the incidence of long-term heart failure. Successful mitral valve repair can return the patient to a normal life expectancy curve.”

“The most common structural cause is myxomatous degeneration, also known as Barlow’s Syndrome, or the more familiar mitral valve prolapse,” said Simmons.

“The valve can also leak because of ischemic heart disease in patients who have had heart attacks and have impaired heart function.”

“Indications for mitral valve surgery vary from seemingly asymptomatic patients with enlarged but well-functioning left ventricles to patients with severely depressed left ventricular function. Even relatively symptom-free patients should be considered, for surgery, if there is objective evidence for even minor ventricular deterioration. Sometimes, the symptoms are only evident with stress testing by a cardiologist.

“It should be emphasized that patients should have treatment before the heart function deteriorates to achieve better long-term outcomes and reduce the incidence of long-term heart failure. Successful mitral valve repair can return the patient to a normal life expectancy curve.”

REPAIR LESS RISKY THAN REPLACEMENT

Although the first MVR occurred in 1923 on a 12-year-old girl with rheumatic mitral stenosis, the procedure fell from favor during the 1960s, when artificial valves were first used widely.

For More information Click the Image Above.

FOR MORE INFORMATION CLICK THE ABOVE IMAGE.

For years, replacement of the mitral valve with an artificial or bioprosthetic valve was the surgery of choice for patients with a severely damaged mitral valve, but it carried complications that include higher incidences of mortality.

Repair, on the other hand, has a risk of only one to two percent of surgical mortality, versus six to eight percent for replacement. It also offers the benefit of lower risk of stroke and endocardial infection, as well as improved long-term survival.

Valve replacement also requires a lifelong dependency on blood thinners; blood thinners are not required with repair. Mechanical valves can last the patient’s lifetime, but bioprosthetic versions have a lifespan of 10 to 15 years.

IN 1923 DR. ELLIOTT CUTLER performed the world’s first successful heart valve surgery - a mitral valve repair. The patient was a 12-year-old girl with rheumatic mitral stenosis.

IN 1923 DR. ELLIOTT CUTLER performed the world’s first successful heart valve surgery – a mitral valve repair. The patient was a 12-year-old girl with rheumatic mitral stenosis.

In some cases, the mitral valve is beyond repair and must be replaced, but in about 80 to 90 percent of cases, the valve can be repaired, says Simmons. However, because many surgeons are not experienced with mitral valve repair, they still prefer to replace the valve.

“I always stress the fact that the valve should be repaired if at all possible,” said Simmons.

“This preserves the natural shape and function of the heart. If the valve can’t be repaired, then it can be replaced with either a bioprosthetic valve or a mechanical valve.”

MVR TECHNICALLY CHALLENGING, RESULTS GRATIFYING

Neither repair nor replacement are easy procedures, since both cases require the use of cardiopulmonary bypass – or the heart-lung machine – and the patient must also spend a couple of days in the intensive care unit. The payoff of repair is particularly huge.

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The Mitral Valve, critical to the proper functioning of the heart, serves as the gate from the left atrium – where blood oxygenated by the lungs is collected – to the left ventricle, the powerhouse chamber responsible for pumping blood to the entire body.

“Mitral valve surgery can be complex and challenging for the surgeon, but a successful repair can be very rewarding to the patient in terms of relief from symptoms of heart failure,” said Simmons.

“The surgery can take three to four hours and most patients will go to an ICU setting for one to two days. Patients can generally go home in less than one week.”

The repair procedure includes a full or partial sternotomy, where the surgeon cuts through the breastbone and spreads the ribs to access the heart. A minimally invasive technique is also available.

“The surgery can be done via the traditional incision in the front of the chest, which has an excellent proven track record, or it can be done through multiple small incisions on the side of the chest,” said Simmons.

Sternotomy continues to be the optimal method because it affords the surgeon the best vision and access to the heart. The surgeon may fix abnormal motion of the valve leaflets and repair chords.

Sternotomy continues to be the optimal method because it affords the surgeon the best vision and access to the heart. The surgeon may fix abnormal motion of the valve leaflets and repair chords.

The latter involves the use of robotic arms with tiny instruments and a tiny camera placed through the ports. The surgeon controls the movement of the arms from a computer.

Sternotomy continues to be the optimal method because it affords the surgeon the best vision and access to the heart. The surgeon may fix abnormal motion of the valve leaflets and repair chords.

The primary repair method is annuloplasty, the placement of an artificial ring around the annulus to reinforce and restore its size and shape. For Patsy Hothan, the surgery was definitely worth all the effort.

FOR MORE INFORMATION about mitral valve repair and for a Health First Medical Group physician referral, call 321-434-4335 and press Option 3, or log on to Health-First.org/Physician


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