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Cardiothoracic Surgery

Early, less invasive treatment benefits mitral valve patients


Cardiothorasic Mitral Valve TreatmentThe current trend at leading treatment centers is to identify patients with a variety of mitral valve diseases early and to follow them closely. The goal is not only to determine how patients’ valve conditions are affecting them symptomatically, but to also learn how their heart is responding to the hemo-dymanic burden of inefficient circulation that results from narrowed or leaky valves. Mitral valve disease can lead to secondary changes in the heart — including atrial or ventricular cavity enlargement — that can result in arrhythmia or reduced heart function. Early correction of mitral valve conditions can reduce these secondary changes and result in better long-term health.

Sophisticated medical imaging is a key factor in managing patients with valve disease. UCLA has helped to advance the use of real-time 3D echocardiography to evaluate and monitor patients with valve disease and to help plan their treatment. The 3D images can provide useful anatomical insights that would not be available in a standard two-dimensional image.

Minimally invasive, robotic surgery

In addition to treating valve disease earlier, surgeons and patients are more frequently choosing minimally invasive surgery. A minimally invasive approach reduces the need for supplemental blood during surgery, postoperative pain and complications related to the incision, while recovery time and the cosmetic result are improved. The same repair that is conventionally performed through a full sternum split can be done through a small opening, usually made in the crease under the right breast.

At UCLA, the cardiothoracic surgeon’s ability to perform operations through small openings is enhanced by the use of surgical robotics. Working from a console that displays a 10- to 15-fold magnified view of internal heart valve structures from a camera inside the heart, the surgeon operates a pair of hand controls that direct micro-insturments to reproduce those hand motions inside the patient’s heart. The device’s electronic interface can translate the surgeon’s movements for greater precision. A 3 cm hand movement, for example, can become a 3 mm movement at the end of the instrument within the patient’s heart.

Because of the expense of the robotic equipment and the level of experience needed to master the techniques, very few surgeons achieve world-class stature in minimally invasive, robotic mitral valve surgery.

Minimally invasive valve surgery is associated with significantly reduced disability and shorter overall recovery. Patients who undergo these procedures typically have a hospital stay of less than five days and are fully recovered in about three weeks. For the open procedure, the recovery period typically spans from six weeks to two months.

Valve repair and valve replacement

Most patients are eligible for mitral valve repair, which is preferred over valve replacement because use of the patient’s own tissue avoids issues of life-long anticoagulant therapy and replacement valve long-term durability. Some natural valves — often in patients with rheumatic fever — are so calcified and scarred that they require replacement. Though the surgery isn’t one that benefits from a robotic approach, valve replacement can be performed using minimally invasive techniques. New replacement valves are available that are more durable and require lower levels of anticoagulation than earlier models.

 Patients undergoing either valve repair or replacement procedures can be treated for arrhythmia at the same time using the MAZE procedure. This technique produces a series of strategically placed lines of scar tissue in the atrium near the focus of abnormal electrical activity. The scar tissue helps channel electrical impulses to travel in a way that causes the heart to beat efficiently.

Expertise in minimally invasive techniques and surgical robotics

Current guidelines from the American College of Cardiology and the American Heart Association for patients with surgically repairable mitral valve disease call for early treatment. “We have learned that you have to intervene earlier, very often when the patients aren’t even symptomatic,” explains Richard J. Shemin, M.D., chief of cardiothoracic surgery and co-director of the UCLA Cardiovascular Center. “Early intervention improves their life expectancy and symptomatic status and wards off secondary heart problems related to the valve condition.”

Minimally invasive surgery offers patients many advantages over a full sternum split. Mitral valve patients at UCLA can also benefit from the use of surgical robotics, which provide an improved view of the surgical field and finer control of surgical instruments.

Experience is among the keys to success at UCLA. “The average surgeon in the U.S. probably does five to 10 mitral valve operations per year — we often do that many in two weeks,” states Dr. Shemin.

Team Members

Richard J. Shemin, M.D.
Robert and Kelly Day Chair of Cardiothoracic Surgery
Professor and Chief, Division of Cardiothoracic Surgery
Co-Director, UCLA Cardiovascular Center

Curtis Hunter, M.D.
Assistant Clinical Professor of Surgery
Director of Cardiothoracic Surgery
UCLA Medical Center, Santa Monica
Director of Endovascular Stenting
Ronald Reagan UCLA Medical Center

Allison Chavarria, ACNP
Division of Cardiothoracic Surgery

Christian Eisenring, ACNP
Division of Cardiothoracic Surgery

Contact Information
(310) 206-8232 Appointments and referrals
(310) 825-7473 Fax

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