“Why Is Mitral Valve Repair Preferred To Mitral Valve Replacement?” Asks Donald
By Adam Pick on June 21, 2011
Recently, I received a great question from Donald, a 64-year old patient, who suffers from mitral valve regurgitation. While evaluating his surgical options, Donald asked me, “Adam – My research suggests that mitral valve repair surgery is preferred to mitral valve replacement… Why is that?”
I was very fortunate to discuss Donald’s question with Dr. David H. Adams, a leading heart valve surgeon who specializes in mitral valve reconstruction, at the Mitral Conclave in New York City.
Thanks to Donald for his question and a special thanks to Dr. David Adams for his ongoing support of our community. To learn more about Dr. Adams, who is the Chairman of Cardiothoracic Surgery at Mount Sinai Hospital, please click here.
If you are hearing impaired, I have provided a transcript of this video interview below.
Adam: Hi Everybody, it is Adam and we are coming to you live from the Mitral Conclave in New York City and I am very fortunate to be with Dr. David Adams who is the program director of The Mitral Conclave. We have a question that came in specifically for you, from HeartValveBlog.com and if it is okay, I would like to ask you that question and see how you respond.
This question comes from Donald and he writes; I am 64 and need mitral valve surgery due to severe regurgitation. My research suggests a repair of the mitral valve is preferred over replacing the mitral valve. (To learn more about mitral valve repair surgery, click here.)
He has a great question. Why is that?
Doctor David H. Adams: Adam, I can give you several answers to that, but I will start with the simple biological fact. If you think about almost anything we have to have surgery for, nature wins every time. We can make an artificial joint, we can make an artificial valve, we can create a dialysis machine, we can put you on a ventilator, but there is not a single example I can think of where what man makes is better than what nature creates. We shouldn’t be surprised to find out that inside our heart we have a very special valve called the Mitral Valve that controls blood flow from this collecting chamber from the lungs, to the pumping chamber to the left heart and it sees, it opens and closes 60-70 times a minute our whole life and it sees this incredible pressure in volume of the heart beating to put blood out to our bodies. It is not a, it shouldn’t surprise us that anything we make to try and replace this amazing structure inside the heart, likely isn’t to last as long or perform as well.
I think that is the main issue. In reality, what we like to talk about is event free survival. A heart valve replacement procedure is better than having a damaged valve. I would rather have a prosthetic valve than a damaged non-functioning mitral valve, but I would much rather have someone reconstruct my own valve. This whole meeting, the Mitral Conclave, has really been about the techniques that really allow that to happen everyday in almost every patient with prolapse degenerative disease.
- Your own tissue doesn’t get infected.
- Your own tissue doesn’t really develop structural valve degeneration.
- Your own tissue cant develop a leak around the prosthetic sewing ring where you tie a prosthetic valve in.
All the series, not only long term, but all the series that have looked at this to every single paper documents that survival is better with mitral valve repair than mitral replacement. There are just certain things that happen with valve replacement, to the ventricle, and the risk of a rupture of the place where the mitral prosthesis sits — that does not occur with mitral valve repair.
Except for really critically ill people where their survival is not so much determined by which mitral operation they got, in those patients I don’t think there is a significant difference the typical young healthy patient 40, 50, 60 even 70 years old.
We just published a paper in The European Heart Journal looking at Octogenarians. We combined our series with the top center in Europe, with Fred Mohr in Germany, and we found even octogenarians survival advantage to mitral valve repair versus replacement. One of the many take home messages of this meeting today is we have got to repair mitral valves because it translates into years of life for individual patients.
I always tell every patient that nothing lasts forever. Especially younger patients, no in this age group I could expect this to be his only operation. For young patients, I operate on lots of patients that ate 20, 30, 40 years old, I tell them the field has only been around 30 or 40 years I want them to live to be 90. That is what the expectation is in the United States today. We obviously don’t know whether something else will need to be done. What we do know it that a well performed valve repair has the best chance of any operation we can do, whether a mechanical replacement, bio-prosthetic replacement, the best chance of never needing another operation is to get a great valve repair.
Adam: Dr. Adams as always I just want to thank you on behalf of all the patients and he caregivers out there for all that you are doing, the research and the clinical work and getting all of these surgeons together at the 2011 Mitral Conclave. I wanted to acknowledge you and I also wanted to congratulate you on a great event and thanks for everything you do. I really appreciate it.
Dr. Adams: Adam, thanks very much for your support on behalf of the patients.
Keep on tickin!