Adam's Heart Valve Surgery Blog

Since having my aortic valve replaced via the Ross Procedure in 2005, I’ve received a number of questions about this unique double heart valve replacement. One of the most common questions is, “Isn’t that operation more risky as two valves are replaced?”

I have to admit, that is a very fair question. I remember thinking the same thing when both Dr. Trento and Dr. Starnes suggested this relatively uncommon surgical approach. However, as I did my research on the Ross Procedure, the benefits started to outweigh the risks.

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Recently, I was extremely lucky to observe Dr. Saibal Kar and his team perform its 103rd MitraClip procedure on a patient with severe mitral regurgitation at Cedars-Sinai Hospital in Los Angeles, California.

Dr. Saibal Kar And Me In The Cath Lab At Cedars-Sinai

While I expected to watch the procedure from a gallery – much like an episode of Grey’s Anatomy – I quickly found myself inside the cardiac catheter lab wearing scrubs and a lead suit used to protect me against x-ray exposure from fluoroscopy.

For the next three hours, I had front-row access to Dr. Saibal Kar’s team as they cared for the patient and deployed the new MitraClip device. Yes… This was much, much, much better than an episode of Grey’s Anatomy.

Although the MitraClip has yet to receive FDA approval in the United States, Dr. Kar has been using the device to treat mitral valve regurgitation without causing any physical trauma to the patient’s sternum or ribs. As previously discussed, the results of the MitraClip clinical trials have been encouraging.

A few minutes before the procedure began, I was very surprised to see a familiar face enter the cardiac catheterization lab. Doctor Alfredo Trento, the Chief of Cardiothoracic Surgery at Cedars-Sinai Hospital, quietly assumed a position to left of Dr. Kar.

Dr. Kar (Cardiologist) and Dr. Trento (Cardiac Surgeon)
Work Side-By-Side During A MitraClip Procedure

“This has got to be somewhat unique,” I thought to myself, “Given the distinct nature of their specialties and some of the skepticism surrounding the MitraClip from the surgeon community, I can not imagine this is common.” (I would later learn that, so far, only a handful of cardiac surgeons have taken a serious clinical interest in this non-invasive procedure used to treat mitral valve regurgitation.)

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In 2009, many public figures, including Barbara Bush and Robin Williams, needed aortic valve replacement due to heart valve diseases including aortic stenosis. One might think that their successful results and the improvement in mortality rates would inspire patients and the medical community to view heart valve surgery as a blessing.

However, fear about the risk of surgery is among the reasons half of eligible patients are not getting aortic valve replacement surgery, according to a study by physicians at the University of Michigan Health System.

The study, published in Circulation: Cardiovascular Quality and Outcomes, found that 66% of patients who did not have aortic valve replacement were suffering symptoms such as shortness of breath that would have improved if they had the surgery.

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I was just reading the New York Times when I came across a very interesting study about the use of “off-pump” techniques for heart surgery.

The study, just published in the New England Journal of Medicine, suggests that use of heart-lung machines may actually provide enhanced surgical outcomes (inclusive of pumphead) when compared to beating heart procedures.

The highlights of the study, which evaluated 2,203 patients that were randomly assigned to have bypass surgery on-pump or off-pump, were:

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