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The High Tech Heart: The Latest in Mitral Valve Repair

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The mitral valve is often called the "inflow valve" to the left ventricle of the heart. The left ventricle is considered the heart's main pumping chamber. Blood and oxygen flow from the lungs into the open mitral valve and then into the left ventricle. When your heart squeezes, blood and oxygen get pushed out of the left ventricle and then travels throughout the body. At the same time, two flaps on the mitral valve snap shut, preventing the blood from backing up into the lungs.

Generally, patients need a mitral valve repair for two reasons: either the valve is too tight to allow sufficient blood to flow into the left ventricle, or the valve is leaky. A leaky valve causes blood to back up and go in the wrong direction, rather than directly into the pumping chamber. This is called regurgitation.

A heart murmur is one of the most common precursors to the more serious problem of regurgitation. People can have heart murmurs for years without any negative effects, but as time goes on, in some cases, the condition becomes more serious, creating the need to repair or replace the mitral valve.

Mitral valves can be surgically repaired or they can be replaced. Replacement valves are made from mechanical materials-plastic, carbon or metal-or from animal tissue or the tissue of a donated human heart. Mechanical valves are generally stronger, but blood has a tendency to stick to them and form clots, so it's necessary to take blood-thinning medications for the rest of your life. Valves made from animal or human tissue are not as strong as mechanical ones, so they may need to be replaced after about ten years. On the other hand, they generally don't require you to take blood-thinning medication.

Surgical repair of existing valves is generally the more desirable approach, but typically it can only be done if the valve is not extensively damaged.

Minimally invasive valve repair: appropriate for specific types of cases

Traditional surgery for mitral valve repair involves making a large incision in the breast bone, or sternum. But in some cases, surgeons are now able to perform minimally invasive valve repair surgery. This uses several small incisions instead of one large one, which makes for a less painful recovery. Minimally invasive surgery typically makes your hospital time shorter and your recovery faster.

You may qualify for minimally invasive surgery if:

  • Your mitral valve is not severely damaged
  • You need only one heart valve repaired
  • You do not have clogged arteries
  • You are not obese

    In some cases, surgeons can perform minimally invasive valve repair with the aid of a robot. During these procedures, the surgeon sits at a console table to control the robot's surgical "arms." The robotic system provides images that are more precise and detailed than what surgeons can see with their own eyes. The view is magnified to the tenth power. And unlike other types of minimally invasive instruments, the instrumentation of the robot is flexible enough that it can rotate and turn in the way that a surgeon's wrists do.

    As hospitals around the country gradually add more minimally invasive procedures and their surgical teams learn to apply them to their specialties, heart patients can expect, in the near future, to have cardiac surgery with incisions that are easier to recover from, less scarring, perhaps less time on a breathing tube and an improved experience overall.



    Source:
    National Heart, Lung, and Blood Institute; New England Journal of Medicine, 3 March 2005



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