Fresh From the OR, a Heart Surgeon Chats With Users

Mihaljevic: Leaky aortic valves can oftentimes be repaired using a minimally invasive approach. Repairs are usually performed at specialized centers and can be done with a minimal risk and excellent long-term results.

If the aortic valve repair is accomplished, patients can resume all regular activities of daily life, including getting married.

mary: They mentioned the ring is very important to a valve repair surgery. If I am looking for valve repair surgery, should I make sure they also include a ring in my surgery?

Dr. Mihaljevic: Absolutely. The purpose of the ring is to prevent the later deterioration of the function of the mitral valve.

nnsmith: Can you have robotic surgery after traditional open-heart?

Dr. Mihaljevic: The answer is yes. Robotic surgery is an option for a selected group of patients that had previous open-heart surgery. Whether the robotic surgery is an optimal approach depends largely on the type of surgery that was provided in the past.

CCH: Dr. Mihaljevic, what do you think the future of robotically assisted heart surgery will be?

Dr. Mihaljevic: The future of robotically assisted heart surgery will be an even broader use of robotic approaches that will continue to minimize the trauma to the patient and enhance the chances of early recovery.

Trudy: Eleven years ago, I had a double bypass surgery, and the TE report shows some aortic valve mild regurgitation and the tricuspid valve shows some mild regurgitation pulmonary valve N/D and mitral valve regurgitation moderately severe. Could this be corrected during the same operation? And verify that the bypasses are still in good working condition? And if not, replace them at the same time?

Dr. Mihaljevic: The answer is yes, provided that the severity of leakage through the mitral valve truly warrants surgery. Patients who had bypass surgery in the past may have mild to moderate leakage through the mitral valve—but that does not pose the need for surgery.

Before you get to surgery, you would need a detailed echocardiogram and most likely a repeated cardiac catheterization to assess the condition of your previous bypasses.

michael48: Does a history of AF and PVs with moderate to severe mitral regurgitation complicate the surgery outcome?

Dr. Mihaljevic: This is a common observation in patients who have mitral regurgitation. Atrial fibrillation can be treated successfully by doing a Maze procedure at the same time as doing a mitral valve repair.

CCH: It sounds like robotic surgery has so many benefits. Why wouldn't all surgeries be robotically assisted?

Dr. Mihaljevic: The robotic surgery requires a specially trained surgeon and surgical assistants in the operating room—an entire surgical team. That is the main reason why this is being performed in very specialized centers with a greater experience in cardiac surgery.

There are only certain patients with blockage in their heart vessels who are potential candidates for robotic bypass surgery. We are most likely going to see a greater use of this technology for treatment of coronary artery disease in the future.

bimals77: Aortic valve repair, is this a lifetime solution for a leaky valve for a 30-year-old male?

Dr. Mihaljevic: It is a potential lifetime solution for patients upon whom aortic valve repair can be performed. Based on your age, I would assume you would have a bicuspid aortic valve, which means that your aortic valve is made out of two cusps instead of three. If that is the case, you have a 70 percent chance for successful repair of your valve using a minimally invasive approach (however, without a robot).

liswife: What would cause "heart failure" after robotic mitral valve repair? Prior to surgery ejection rate of 60; after surgery rate of 35?