“Is Mitral Valve Re-Repair Possible?” asks Jeanie
By Adam Pick on January 18, 2018
The possibility of heart valve “re-operations” is known within our community. As patients, we hope that only one valve procedure is needed during our lifetime. However, the reality is that patients may need one or more re-operations.
Specific to this topic… Jeanie recently asked me, “Hi, Adam. I’m 63 years old. I just had mitral valve repair surgery performed in April of 2017. Now, a few months later, I have moderate to severe leakage again. Can this be re-repaired or do I need to have it replaced?”
To answer Jeanie’s question, I was very lucky to interview Dr. David Adams who is the Cardiac Surgeon-in-Chief of the Mount Sinai Health System in New York. If you didn’t know, Dr. Adams is a mitral valve guru who started the Mitral Conclave Conference and co-wrote the book, Carpentier’s Reconstructive Valve Surgery. In addition, Dr. Adams has successfully treated over 100 patients in our community including Sophie Marsh, Brian Walsh and so many others.
Many thanks to Jeanie for her question and a special thanks to Dr. Adams for sharing all of his research and experience with our community!
Keep on tickin!
P.S. For the hearing impaired members of our community, I have provided a written transcript of this video below.
Adam Pick: Hi, everybody. It’s Adam. We are at the Heart Valve Summit in Chicago, Illinois. I am thrilled to be here with Dr. David Adams, who’s the co-director of the Heart Valve Summit. He’s also the cardiac surgeon and chief of the Mount Sinai Health System in New York. Dr. Adams, it’s a pleasure to see you again. Thanks for being here.
Dr. David Adams
Dr. David Adams: Great seeing you, Adam.
Adam Pick: As you know, we’re answering questions that came in from the patient community at HeartValveSurgery.com and on our Facebook page. Got a question from Jeanie Frump and she asks, “Hi, Adam. I’m 63 years old. I just had mitral valve repair surgery performed in April of 2017. Now, a few months later, I have moderate to severe leakage again. Can this be re-repaired or do I need to have it replaced?”
David Adams: Adam, we’ve been very interested in following mitral valve repair patients, and have actually published different papers and opinions about failure of mitral valve repair. What Jeanie’s facing is an early failure. It’s important, first, to know what the original operation was before, because there are lots of different diseases that can cause mitral valve regurgitation. Let’s presume it was prolapse, the most common disease in early failure; almost always is re-repairable.
The first thing I would tell a patient is to relax and take a deep breath because it’s possible that you will be able to be followed with that. It’s not the result you want, but we see lots of patients from around the country that have had failed valve repairs. First thing we do is do a workup to make sure that it’s time to re-intervene. Oftentimes, we will get to know patients and follow them, see them early before we make a decision about re-operation. At the time of re-operation, what we’re looking for is a mobile anterior leaflet. As long as the anterior leaflet is mobile – in our center, we almost always do valve re-repair, but we have a very specific interest in valve re-repair and published and presented large series about re-repair. I think that – you know, your mitral valves are living piece of tissue. Whenever it’s possible to preserve it, including in a failed repair setting, it’s a good idea to go find someone that can do that.
Adam Pick: Finding someone, Dr. Adams – I’m sure Jeanie and other patients who have this issue. I understand that re-operations – heart surgery’s tricky to begin with, but when you’re doing a re-op for a valve is it more difficult and more challenging? If so, what should patients do about that?
Dr. David Adams: Re-operations present some new technical challenges. Fortunately, cardiac surgery is a field that the re-operative part of that has gotten much safer in the last decade. In terms of valve re-repair, this requires a lot of experience. I would tell patients that may require a re-operation to make sure that you’re with a surgeon in a center that has done mitral valve re-repair because this is a super specialty. All valve repair is a specialty, but mitral valve re-repair is honestly a super specialty. I think, depending on your pathology and anatomy, if you are a re-repair candidate, that’s what you should have.
Adam Pick: Dr. Adams, thank you for everything that you’re doing to advance valvular therapy, specifically mitral valve, all the great work that you’re doing here with these clinicians. Getting them together to learn from each other and just get our patients doing well again. Thank you for everything you’ve done over the years. It’s an honor to have you here.
Dr. David Adams: Thanks, Adam.