Surgeon Q & A: Treating Mitral Valve Disease and Atrial Fibrillation Simultaneously With Dr. Harold Roberts
By Adam Pick on November 1, 2012
While reading through your questions submitted for the Heart Valve Summit, I noticed several patients asking about treating mitral valve disease and atrial fibrillation at the same time.
For that reason, I met with Dr. Harold Roberts, a very experienced valve surgeon. Here are the highlights from our discussion. (If you are hearing impaired, I have provided a written transcript of this video below.)
Thanks to Dr. Harold Roberts for taking the time to share his clinical experiences and research with our patient and caregiver community!
Keep on tickin!
P.S. Here is a written transcript of my video interview with Dr. Roberts:
Adam: Hi everybody, it’s Adam with HeartValveSurgery.com. We are here at the Heart Valve Summit in Chicago, Illinois. I’m very happy to be sitting next to Dr. Harold Roberts. Our patients have had great results with Dr. Roberts — including Tom Devine and Terry Tannenbaum. Thanks so much for being here today.
Dr. Harold Roberts, MD: Thank you.
Dr. Roberts: First, I want to talk about what atrial fibrillation is… It’s when the upper chambers of the heart doesn’t contract in a rhythmic fashion and because of that it decreases the efficiency of the heart. Most importantly, because of the stagnation of blood in the upper chambers –particularly left atrium – clots can form and these can break off and go to the brain. In fact in the United States, atrial fibrillation is responsible for 20% of all strokes due to patients that have atrial fibrillation. If you are needing a valve procedure done, it is really important that the surgeon you choose has the facility to also deal with atrial fibrillation.
Adam: For the patients that are diagnosed with mitral valve regurgitation and artial fibrillation, are these conditions treated at the same time during one procedure? Is that a minimally invasive procedure?
Harold Roberts, M.D.: Very good questions. We treat them at the same time. I can perform a Cryo Maze procedure. I use a device that replicates the Cox Maze procedure. The Maze procedure was first devised in 1987 by Dr. James Cox and it basically forms these scars in the left and right atria that make it where electrical signals can not pass those little lines that we make in the left and right atria and causes the aberrant signals that cause atrial fibrillation to dead end into these mazes. This allows the normal signal to come through. So, the patient who has been in atrial fibrillation for couple of decades, we can do this procedure with a very high percentage cases it will covert them back to a normal rhythm.
Adam: Do all surgeons have ability to treat both the mitral valve issue and atrial fibrillation issue at the same time?
Doctor Roberts: Unfortunately, no. If you look at the STS database only about 50% of patients that have atrial fibrillation that go to open heart surgery get a Maze to get rid of it. Atrial fibrillation is responsible for 20% of strokes. It greatly diminishes the quality and quantity of the patients’ life. They are relegated to being blood thinners like Pradaxa or Coumadin. They can’t participate in contact sports. If they fall and strike their head, they can have that what would be just a bump on the head can turn into catastrophic event. I think it’s exceedingly important that if you have atrial fibrillation and you are going to need a valve procedure that you insist the surgeon address atrial fibrillation at the same time with the Maze procedure. One thing I would ask the prospective surgeon is “How long you have been doing it?” and “What is your success rate?” Because it is equally important to get rid of the atrial fibrillation and to resolve the valve issue.
Adam: What are the success rates of treating both valve disease and atrial fibrillation at the same time?
Doctor Harold Roberts: Our success rates have generally been well above 90-95%. That includes the patients who have had it over 20 years.
Adam: On behalf of the patients and caregivers out there, thanks for stopping by and spending some time with and sharing you expertise with all the member of our community.
Dr. Roberts: Thank you.