“Is Robotic Mitral Valve Repair Surgery Safe Compared to a Sternotomy?” asks Ken

I received a great question from Ken. In his email, Ken writes, “Hi Adam – After being diagnosed with mitral valve prolapse in 1995, I now need surgery to fix the valve. During my research, I have come across robotic valve repair surgery. My question… Is this procedure safe compared to a sternotomy?””

To answer Ken’s question, I recently met with Dr. T. Sloane Guy, MD the chief of cardiovascular surgery at Temple University Hospital. The highlights of our conversation are provided in this video interview. (For the hearing impaired members of our community, I have provided a written transcript below.)

I hope that helps you learn more about the safety, the benefits and the outcomes for robotic mitral valve repair techniques — in the hands of a very experienced surgeon. Many thanks to Dr. Sloane Guy for sharing his clinical experience and research with our community.

Keep on tickin!
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P.S. Here is a written transcript of my video interview with Dr. Guy:

DR. SLOANE GUY: My name is Dr. Sloane Guy. I am the chief of cardiovascular surgery at Temple University Hospital. I have performed thousands of cardiac procedures, of varying types. About half of those have been valve procedures. Most procedures performed in the United States are bypass surgeries. I do bypass surgery. But, I do more valve surgery than bypass surgery. My original interest in cardiac surgery began with my mentors, starting with Dr. Bill Frist of Vanderbilt University Medical Center. The types of procedures cardiac surgeon do are incredibly interesting and the technical challenges was something that attracted me. I noticed that these heart surgeons are some of the best over-all doctors in the hospital. If you are on a deserted island and you can only have one kind of doctor, you want that guy to be a heart surgeon.

ADAM PICK: Hi everybody, it is Adam with HeartValveSurgery.com. I am here with Dr. Sloane Guy. We are answering your questions that were posted at the website. This question Dr. Guy comes in from Ken, who writes, “Hi Adam. After being diagnosed with mitral valve prolapse in 1995, I now need surgery to fix the valve. During my research, I have come across robotic valve repair surgery. The question is… Is this procedure safe compared to a sternotomy?”


Dr. T. Sloane Guy – Heart Surgeon

DR. T. SLOANE GUY: Absolutely yes. There are many different ways to do mitral valve repair surgery — ranging from a full sternotomy, or cracking of a chest, to so-called mini-thoracotomies, where you make small incisions under the right breast. The real advantage, in my opinion, of the robot is, it allows you to make probably, the smallest possible incisions to accomplish a mitral valve repair. In my practice, my largest incision for a robotic mitral valve repair is 15 millimeters. There is no way you can do the operation through that size incision without the robot. But, the robot is just an instrument, the surgeon controls it. The difference between that and standard instruments is its range of motions. And that allows you to essentially crawl in, into the patient’s left atrium, inside their heart, with the camera, with the instruments and have the same range of motions as you would have with your own hands. That is the real advantage. It is the small incisions and the ease of use of the equipment.

ADAM PICK: Can you tell me what the benefits and expected outcomes of Robotic Mitral Valve Repair surgery?

T. SLOANE GUY, MD: So the greatest benefit is that the incision size is incredibly small. We do not do any rib spreading — which is what causes a lot of the pain from the mini-thoracotomy or port access procedures. We do not split the sternum, which causes a lot of pain. So the pain is clearly less. Our lengths of stays are less. Our expected length of stay after this operation in a healthy person would be about three (3) days. And I think the greatest benefit is actually the period of time after the patient is discharged to when they would have healed from a standard operation. The patients tend to recover more quickly. If you want to play golf the week after surgery, this is really the only option.

The Da Vinci Robot Used For Mitral Valve RepairDaVinci Surgical Robot for Mitral Valve Repair

ADAM PICK: Can you tell us what your experience in terms of outcomes and repair rate is for someone with mitral valve prolapse?

DR. GUY: With mitral valve prolapse or myxomatous prolapse of the mitral valve, the repair rate is, and should be, near 100%. Almost all those patients can be repaired. If the amount of prolapse is complex, they really need to be treated at what we would call a “reference center” or “center of excellence” that focuses on it and does a lot of them. No patient with myxomatous disease should get anything but a repair, by and large. I am very much a believer in empowering patients. I think the internet has gone a long way to doing that. But I think, patients need to become familiar with all the options. One of the things I tell all my patients is that there is about 10 ways to fix your mitral valve. I have done all 10 and I can introduce you to a surgeon — who I would trust with my own family — that does it each of those 10 ways. I believe our way is better because we make the smallest incisions. Do not simply take a referral from your cardiologist and go sign up. Spend the time to learn about the procedures, go on the internet, even seek second opinions before you decide who to go to, because that is a very, very important decision.

 

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.

To learn how Adam has helped millions of people with heart valve disease, watch Adam's video, subscribe to his free newsletter, or visit his Facebook, or Twitter pages.

  • Ellen Ridsdale

    Hi Adam,

    Thanks for posting this information. I have moderate MR and have been hoping that by the time I require surgery this will be the common practise. I also have mild aeortic leaking. Would this affect a surgeons ability to repair with the robot?

    Thanks
    Ellen

  • Ken Feeser

    I had Robotic MVP repair in Nov 2010 and highly recommend this approach. I remember all my research and anxiety in deciding on the best hospital and surgeon for me. I’d be happy to answer any questions.

  • Doug

    Having recently had NON-ROBOTIC port access surgery to repair ruptured chordae to the mitral valve leaflets, and being 57 and healthy, I can’t say that the robotic approach sounds much different from the recovery perspective. I also had 3 days in the hospital and rapid incision healing. Yes, I had ribs spread as part of the procedure, but can’t say there was significant pain or any lengthened recovery from that. So unless you have an aversion to the larger (?) 4-5″ scar that comes from non-robotic port access – which I didn’t – then it may come down to your choice in surgeon and their comfort/preference with instruments. Mine obviously preferred a more “hands-on” approach. I was okay with that as the outcomes seemed to predict similarly (no improved outcomes from robotics). Of course, I’m just a patient, not an expert.

  • Joyce beck

    I had 2valves repaired at st. Joseph’s hospital In Atlanta, ga 13 months ago. My story is listed on Adams blog. A dr Murphy did my surgery. I thank god every day that I chose this path with robotic surgery. I was up and out of the hospital in 3days. They sent me home with 100 pain pills and I only took 2. I am so thankful I chose this way to go. Had other options but this is the best. Joyce beck

  • john chandler

    hi
    i had mitral valve replacment 2 years ago, my valve was very calcified, after trying to repair the decision was made to replace i think if my memery is correct 28mm paramount.

    I live in Australia and robot surgery was not avaliable then. it is now but at a very high price so i did a vast amount of research and decided to go to Dr Narash Trehan from the Medacity in India, he has done many 1000s of these operations . I can really recommend this type of surgery..mine was 100% sucsesfull the hospital was first class also,

    I have had 3 EG in the last 2 years there is no leakage, The Dr.s hear that i have seen are very impressed with the results, in fact my doctors are all very interested as they have not seen the startling results from robotic valve surgery . So yes i made the best decsion for me

    John Chandler

  • Linda

    A well known surgeon that I met with advised me that non-invasive surgery has a 1% chance of causing a stroke, whereas robotic surgery has a 3% chance of causing a stroke. This is the reason that this particular surgeon doesn’t use robotic surgery. Why would this be the case?

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