Fresh From the OR, a Heart Surgeon Chats With Users

Dr. Mihaljevic: Mitral valve repair can be performed even after a failed earlier attempt to repair the valve. Repeated operations on a mitral valve can be accomplished robotically in some cases and with very low risk.

Patients who get their mitral valve repaired in their 40s are most likely going to enjoy a lifelong benefit from surgery. The failure rate from the operation is only 10 to 15 percent over a 20-to-25-year period.

michael48: What about a person who has MVP with regurgitation and slightly enlarged LA as well as a history of atrial fibrillation treated with Sotolol? An MV repair has been suggested by the cardiologist with a Maze procedure to control the arrhythmia.

Dr. Mihaljevic: I would definitely agree with the recommendation since the enlargement of the LA and the presence of atrial fibrillation are suggestive of an advanced stage of the disease.

Mitral valve repair and a Maze procedure can be done in the same setting using a robotically assisted approach.

mike: The surgery this morning was amazing. Is there ever a time when you need to switch to a more traditional approach?

Dr. Mihaljevic: There are rare occasions when we need to switch to a more traditional approach. But that occurs in less than 2 percent of operations. The switch to a conventional approach can be achieved in less than a minute or two.

doncarrera: How many CT surgeons in the Cleveland-Pittsburgh-Columbus area can perform the MI mitral valve repair?

Dr. Mihaljevic: I am not really certain about exact number of surgeons who perform this procedure. However, you look at centers that provide minimally invasive options, mitral valve repair options, and the volume and outcomes of those procedures. You can compare our statistics to other hospitals--look at our website for those numbers.

namaste1: My daughter had open-heart surgery when she was 1 year old. Tetralogy of Fallot. She is 20 now and one of her valves is leaking. Her surgeon wants to wait before fixing the valve to see if it can be done robotically, but I'm not sure how that works.

Dr. Mihaljevic: The repair of mitral valves for congenital heart disease can often be complex, and whether we can repair her valve using robotic instruments would require a careful review of her medical records.

Heart surgery should not be done at the same setting of reconstructive surgery.

peter59: During the surgery, they said that mitral valve repair was better than mitral valve replacement. Why?

Dr. Mihaljevic: Because the repaired mitral valve performs better over the short and long term than the artificial heart valves. Keeping your own valve reduces the risk of potential life-threatening complications (such as a stroke) that are often associated with artificial heart valves.

Trudy: I am an 80-year-old male with aortic stenosis and mitral valve regurgitation and I want to know if they both can be repaired at the same time.

Dr. Mihaljevic: Patients with aortic stenosis and mitral valve regurgitation usually require replacement of the aortic valve and a repair of the aortic valve. This operation can be done using a minimally invasive approach at the same time.

jbbrown: I need tricuspid valve repair or replacement due to radiation received 24 years ago to the left breast. Would I be a candidate for robotic surgery?

Dr. Mihaljevic: Tricuspid regurgitation after chest radiation is a difficult problem to solve. Although you may qualify for robotic surgery, you will need to be carefully evaluated prior to operation to insure the optimal mode of operation.

bimals77: I am 30 years old. I have a severe aortic leaky valve. I want to play soccer. I want to get married, do whatever I want. What would be the best option?