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Heart Valve Summit Video #7: “Are All Patients Candidates For Robotic Mitral Valve Repair?” Asks Evan

Posted by Adam Pick on November 22nd, 2011

A few days before the Heart Valve Summit, Evan sent me a great question that reads, “Adam – Specific to mitral valve repair with a robot… Are all patients candidates for this surgical technique?”

To provide Evan an expert opinion, I discussed this topic with Dr. Harold Roberts, MD, an experienced heart valve surgeon from Aventura Hospital in Florida. Here are the highlights from our discussion. (A transcript of this interview is provided below for those patients and caregivers in our community who are hearing impaired.)

Thanks to Evan for his great question and a special thanks to Dr. Harold Roberts for sharing his clinical expertise with our community. To learn more about Dr. Roberts and his practice, please click here.

Keep on tickin!

P.S. Here is the video transcript of my discussion with Dr. Roberts:

Adam: “Hi everybody, it’s Adam and we are at the Heart Valve Summit.  We’re answering your questions that were posted at HeartValveBlog.com.  Thrilled to be joined today by Dr. Harold Roberts who practices at the Aventura Hospital in Florida.  The question for Dr. Roberts comes in from Evan, and Evan writes: Adam, Specific to mitral valve repair with a robot.  Are all patients candidates for this surgical technique?”

Heart Surgery Robot
Da Vinci Surgical Robot For Mitral Valve Repair

Dr. Harold Roberts: “Well, I think I can say categorically that, no, not all patients are candidates for this type of procedure.  However, a large proportion are.  But in order to determine if it is indeed in the patient’s best interest to be done through a robotic endoscopic approach, a number of tests have to be carried out.  This would include things like cardiac catheterization.  Patients have, let’s say, a severely leaky mitral valve that needs to fixed; but it turns out that they also have several blockages in their coronary arteries.  Well I don’t think this approach is appropriate, because then those patients would probably be best served by a traditional sternotomy with multiple bypasses and a mitral valve repair at that time.  However, if they don’t have significant coronary disease, their left ventricle is fairly strong; you would not want to, because of the additional time required on the heart lung machine.  You don’t want to use this approach for patients that have really weak ventricles.  Those types of patients are best served by short and sweet, quick operations.  However, it is quite a safe way to go for patients who need complex mitral valve repairs.  Most patients that have leaky mitral valves, valves can be reliably and securely fixed, reconstructed by this technique.  But you would need, number one, to make sure that they do not have significant coronary artery disease.  Also don’t want to do patients, through this approach, through the right side approach; either the mini-thoracotomy or robotic endoscopic approach, if they have severely damaged lungs.  The reason being, when you go through the right chest it can transiently make the right lung a little sick for a temporary time, maybe a day or two.  And if they have marginal lung capacity that type of patient may not tolerate this type of approach.”

Adam: “Great, well Evan I hope that helped you.  I know it helped me learn a whole lot more.  Dr. Roberts, I know you’ve been practicing now for quite some time in Florida.  About how long have you been practicing?”

Dr. Roberts: “I’ve been here since 1990.  And I actually started doing mitral repair after spending a week with Alain Carpentier in Paris back in 1992.  So I’m going on twenty years of doing this and as you can see by my attendance at this valve summit, it is a passion of mine and I attend these types of conferences on a very regular basis.  Probably go to at least 6 or 8 of these a year.”

Adam: “Right.  Thank you so much for stopping by and sharing your information, your clinical work and your research with Evan and the rest of us.  We really appreciate it and I just want to thank you again.”

Harold Roberts, MD: “All right.  Thank you Adam.”

Adam Pick
Written by Adam Pick A dad, a husband and a patient, Adam Pick founded this website in 2006 to educate you about heart valve surgery from diagnosis to recovery.
You can get the latest updates about heart valve surgery from Adam at his Facebook, and Twitter pages. Click here to email him.

 


Lynda Knopf BS/RN says on November 23rd, 2011 at 4:44 am

Dr. Harold Roberts summary on mitral valve robotic repair was very interesting as are all your blog surgical exerps–reality that each cardiac surgical patient is UNIQUE-the cardiac surgeon has to finitely choose the best surgical “road “for each patient, utilizing that patient’s complete medical history–today’s cardiac surgical offerings and successes are AMAZING!….Thank you always Adam for providing your constantly supportive blog–ALSO–Happy Thanksgiving to your lovely family!

 


Vicki Pierson says on November 25th, 2011 at 6:28 pm

I had mitral valve repair in June of this year by “surprise sternotomy.” That is, I actively sought a robotic approach, went through 2 days of pre-op testing, and qualified for a robotic repair (tests included cardiac cath to determine coronary artery health, femoral ultrasound to measure diameter for heart/lung bypass tubing, also imaging of the aorta). My surgeon told me there was a 5% chance that he might have to revert to sternotomy once in the OR. It turned out that I have a connective tissue disorder that precluded the use of my femoral artery for bypass, so I woke up with a sternotomy. Needless to say I was very disappointed. I should have been better mentally prepared, even if the chances were only 5%, but I was trying so hard to avoid the sternotomy that I didn’t want to think about it- and 5% is as close to certainty as it comes in medicine, so I wasn’t worried. Wrong! So my advice is to thoroughly research EVERY method and have a plan for how to deal with it before you go into surgery. If I had done this I think I would have had a better attitude during recovery.

 


Vicki Pierson says on November 25th, 2011 at 6:32 pm

I should add that I had an excellent outcome- very complex repair of my native valve- and good results at cardiac rehab, but the first 6 weeks were really rough due partly to depression, which I am still struggling with.

 

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