Fresh From the OR, a Heart Surgeon Chats With Users

On Tuesday, October 2, U.S.News & World Report and the Cleveland Clinic presented a groundbreaking event—live surgery, streamed in real time over the Internet. Visitors to usnews.com got a rare opportunity to go inside the operating room for an up-close view of cutting-edge heart surgery.

Dr. Tomislav Mihaljevic of the Cleveland Clinic performed the procedure. A specialist in minimally invasive and robotically assisted cardiac surgery, he repaired a leaky mitral valve using a robotic device, going into the heart through a small incision on the right side of the chest. This type of surgery involves much less trauma to the patient than a traditional operation, in which the breastbone must be divided.

Following the surgery, Dr. Mihaljevic answered questions from users in a live online chat. Here's a transcript of that conversation:

Cleveland Clinic Host (CCH): Today's talk is on robotic heart surgery with a follow-up from this morning's [Tuesday, Oct. 2, 2007] live webcast surgery on U.S.News & World Report's website.

CCH: Welcome, Dr. Mihaljevic, and thank you for joining us today. Let's begin with one of the questions!

CCH: It was very exciting to watch the surgery this morning on the Web broadcast, how is the patient doing?

Dr. Tomislav Mihaljevic: The patient is doing just fine. He is now in the intensive care unit. He will probably be out of the hospital in three to five days.

CCH: Before we start to take questions from the audience, can you tell us who makes a good candidate for robotic surgery?

Dr. Mihaljevic: At the current stage, all patients who have leaky mitral valves and or tricuspid valves can be evaluated as a potential patient for minimally invasive robotic surgery. In addition to patients with leaky valves, robotic surgery can also be used to repair holes in the heart (atrial septal defect, patent foramen ovale). It can also be used in a limited extent for certain types of bypass surgery.

bimals77: I am 30 years old. I have a leaky aortic valve. My doctor told me I have to do surgery. I don't want to put in an artificial valve. Please suggest what I should do?

Dr. Mihaljevic: You should send us your records for evaluation. As a 30-year-old, you are certainly a candidate for minimally invasive aortic valve repair, so that valve replacement may not be necessary.

Send us the records for review. The optimal mode of treatment will be made after careful review of your medical records. This type of surgery is done with a minimal risk.

khome: Which valve and how many can be fixed by this type of surgery?

Dr. Mihaljevic: We most commonly perform repairs on the mitral valve; however, the tricuspid valve can also be repaired using robotic technology.

We can do the combination of both of these valves as well during this type of surgery.

markd: How and when would I know that I am a good candidate for aortic valve surgery? How do I find a doctor?

Dr. Mihaljevic: That depends on the type and severity of aortic valve disease. Most patients have aortic stenosis (which is a narrowing of the aortic valve). Timing of the surgery is mostly determined by echocardiogram, an ultrasound of the heart, which accurately determines the severity of disease.

maryp: My mother has been diagnosed with severe mitral regurgitation and is interested in robotic surgery. What are her options?

Dr. Mihaljevic: The robotic surgery is a valuable option even for elderly patients. The operation can be performed with minimal risk. A final decision is always made after a careful review of the records. We would be more than happy to review your mother's records.

katie: I have been diagnosed with myxoma. Is robotic surgery an option?

Dr. Mihaljevic: Yes, it is. Robotic surgery is an excellent option for removal of myxoma, which is a benign growth in the heart.

peter59: What is the probability of reoperation for mitral valve repair on a 48-year-old?