Q: I would like to know how many hospitals/clinics through out the U.S. perform the "minimally invasive mitral valve repair.”
This is not a common approach. I am aware of approximately 10 programs in the United States that have extensive experience with a minimally invasive approach, including the University of Maryland Heart Center.
Q: I am a 47-year-old female with severe mitral valve prolapse and I have just been told by my cardiologist that I will probably need a new valve within the next year. I am going back to him for more information, and will be asking him about repair as an alternative. Meanwhile I'm wondering if chronic sinusitis would rule me out as a surgical candidate for either procedure. I have had three sinus surgeries already, but am still not "perfect." I know about the risks of endocarditis. Will antibiotic prophylaxis cover it or should I be going for more sinus surgery as soon as possible?
There are numerous advantages to mitral valve repair versus replacement. The rate of infection of the replacement valve or repaired valve is considered to be lower after mitral valve repair. In the longest follow-up of patients undergoing mitral valve repair, the risk of endocarditis was only 0.04 % per year.
For replacement, the risk of infection is somewhat higher (approximately 2 % in 10 years) - so the risk is low with either approach, but lower with repair.
Other advantages of repair include:
- Lower operative mortality (1 % vs 6 %)
- Better long-term survival -- better preservation of ventricular (pump) function
- Avoidance of requirement for anticoagulation
- Outstanding durability (freedom from re-operation approximately 95 - 97 % at 20 years)
- Lower risk of stroke in long term (thromboembolism): 0.17 % per year w/repair vs 1 - 2 % / year with replacement
So based on the information you provided, it sounds like you would be best served with a repair.
The repair rate nationwide is approximately 55%, our repair rate at the University of Maryland Medical Center is about 92%. Some valves, such as very diseased rheumatic valves and infected valves with large amount of leaflet destruction are irreparable.
Mitral valve prolapse with severe mitral regurgitation such as you have is considered "degenerative" valve disease, and repair rates for this group should approach 100 %. Where you have your operation performed is critical; ask your surgeon how many mitral valve operations he/she does per year and what the repair rate is.
The sinusitis issue would have to be discussed with you and your ENT physician in advance of surgery. In general, we favor eradicating extracardiac sources of infection prior to valvular heart surgery.
Q: What is the success rate of valvuloplasty (mitral valve repair)?
The success rate of mitral valve repair varies greatly depending on where you have it performed. It depends also on the type of mitral valve disease that you have. In experienced hands (ie, high-volume centers) the repair rate for degenerative mitral valve disease should approach 100%. That has been our experience.
Q: I have been told that I have mitral valve regurgitation and 50/50 chance of either repair or a new valve. My doctor told me to come back in 6 months for a visit and then one year for an echogram. If I do need a repair or new valve can he tell me by the echo and is he taking the correct steps for treating me?
Great question; as we have mentioned before, repair is clearly superior to replacement. The likelihood of repair is highly dependent on the skill and expertise of your surgeon and his/her team. At the University of Maryland, we have a repair rate of 95% for "degenerative" disease, which is most likely what you have.
Q: I had a mitral valve repair, which also included a MAZE procedure. The MAZE procedure failed immediately and I had an ablation nine months later. Now the valve repair with annuloplasty band has failed. Also, my recent echocardiogram shows a three plus regurgitation. Now they tell me I need a pig valve (that only lasts 15 years) and I am looking at two surgeries in the next 15 years. What do you suggest since I am an active skier and mountain biker?
Sorry to hear that you are facing surgery again. It is often possible to re-repair a valve; the mechanism of failure with an annuloplasty ring is often what we call "dehiscience," or a tearing out of the ring from the tissue surrounding the mitral valve. If that is the case, the valve can be easily re-repaired.
Q: I have severe mitral valve regurgitation. Will a repair totally fix the problem?
Yes -- the goal of surgery is to create a competent (watertight) valve.
Q: Why does a patient who has had mitral valve replacement have to take antibiotics before undergoing any dental work?
Any time we brush our teeth, or eat, or have dental work, there is transient "bacteremia." In other words, bacteria present in the mouth enter the bloodstream. Normally they are rapidly cleared.
Occasionally they can land on the heart valves and cause an infection called endocarditis -- infection of the heart valves. It is more common for this to happen when there is an artificial valve present; the bacteria can lodge in the artificial material and infection can occur.
Q: If someone has a mitral valve replacement at age 40 what would be their life expectancy?
That is a hard question to answer; it most importantly depends on the function (strength) of your heart at the time of surgery as well as a host of other factors.