“Will I Need A Mitral Valve Repair Or A Mitral Valve Replacement?” Asks Barbara

A common consideration among patients preparing for valvular treatment is whether or not they will get a heart valve repair or a heart valve replacement.

Recently, Dr. Lars Svensson and I discussed the clinical indicators for aortic valve repair due to aortic regurgitation. Relative to the mitral valve, here is an educational video in which Dr. Jeffrey Swanson answers Barbara’s question, “From a surgeon’s perspective, what differentiates the need for mitral valve repair versus mitral valve replacement due to mitral regurgitation?”

For those of you interested in learning more about Dr. Jeffrey Swanson, please click here. Also, for the hearing impaired, I have provided a video transcript below.

Adam: Hi, everybody. This is Adam and we are here at the STS convention. I’m fortunate to be sitting with Dr. Jeffrey Swanson from Portland and we had several questions come in from the blog post we just put up. One of them was about mitral valve repair versus mitral valve replacement and Barbara wrote me a question saying, “Adam, I’m 51. I’m active. I’ve seen my surgeon. He said that most likely it could be a mitral valve repair, but he may need to replace the valve,” and I want to ask Dr. Swanson, “What, from a surgical perspective, would be the differentiators for having a mitral valve repair being done versus having to have a mitral valve replacement when you’re actually in the operating room.”

Dr. Swanson: Yes. Well, it’s actually a complex question, but most often a surgeon should be able to determine pretty well before an operation based on mitral valve echocardiogram and coronary angiography and other studies that are done prior to surgery whether he’s going to be able to repair a valve or not. And, in fact, a lot of it depends on the surgeon’s experience and how frequently he does mitral valve repair in his practice — how much experience he has with it. The American Heart Association and the American College of Cardiology actually have guidelines for the management of mitral valve regurgitation, severe and moderately severe mitral valve regurgitation, and they say that a patient should be offered mitral valve repair in a hospital and by a surgeon who can guarantee at least a 90% probability of repairing that mitral valve, so those are two important aspects, the hospital where the surgery is performed and the surgeon and his individual experience. So, I think any patient who is sitting with their surgeon and trying to determine what they’re going to — what surgery they’re actually going to have, they should be able to look their surgeon in the eye and ask him, “What his experience is with mitral valve repair?” and “What he would guarantee as a probability?” Most often, now a days, with our preoperative studies, we can guarantee probably within a 98 to 99% probability whether we’re going to be able to repair a mitral valve or not. There are certain circumstances where a mitral valve probably should not be repaired, but they’re pretty unusual.

Adam: I never knew the number was that high just by looking at the echocardiogram and the other tests that you mentioned prior to surgery. But, one other question I have is the importance of second opinions. It comes up often. Are second opinions something you encourage your patients to do or…

Dr. Swanson: I do encourage patients to have all of the information possible prior to undergoing a major operation like this, and a second opinion is good just in terms of general knowledge. Obviously, your website and all the things that you provide are great for patients in terms of preoperative education, but a patient should feel comfortable that they’ve — in terms of the right circumstances for their operation and that they understand what they’re about to go through.

Adam: Great. Thank you, Dr. Swanson, for stopping by. We really appreciate it. You can learn more about Dr. Jeffrey Swanson at HeartValveSurgeons.com. Talk to you soon.

Keep on tickin!

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

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