“Can I Get Robotic Mitral Valve Surgery? Or, Do I Need A MitraClip?” asks Bodybuilder Rich

Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Joanna Chikwe, MD, Chair of Cardiac Surgery at Cedars-Sinai Medical Center
Published: September 22, 2022

I just received a great question from Rich about mitral valve surgery.  In his email, Rich asks, “Hi Adam, I’m a 63-year-old male who competes in natural bodybuilding. Three years ago, I had a mechanical aortic valve replacement. Now, I have severe mitral regurgitation with mild atrium dilation. I have only mild symptoms such as an occasional palpitation. Can I get the mitral valve repaired with a robotic procedure, or is the MitraClip the protocol given my risk factor?”

To provide Rich an expert response, I contacted Dr. Joanna Chikwe, the Chair of Cardiac Surgery at Cedars-Sinai Medical Center, who specializes in mitral valve surgery. As you may know, Dr. Chikwe has performed many successful mitral valve operations on patients in our community including Wendy Spector, Leila Saedi and Scott Wallace.

 

 

Key Learnings About Mitral Valve Surgery & the PRIMARY Clinical Trial

Here are important learnings I jotted down during my interview with Dr. Chikwe:

  • Dr. Chikwe identified three different options that may be available for the treatment of Rich’s severe mitral valve disease including mitral valve repair, mitral valve replacement and the MitraClip. “The valve can be repaired if it’s a prolapsed valve,” states Dr. Chikwe. “If it’s other causes of mitral valve regurgitation, it may be that a replacement is more appropriate. Then, this third option that Rich has asked about, which is the MitraClip, might be an option.”
  • The MitraClip is a transcatheter mitral valve repair (TMVr) procedure which does not require an incision to the patient’s chest or ribs and does not require the use of a heart-lung machine.
  • Currently, the MitraClip is reserved for sick patients who are symptomatic (short of breath, fatigue, etc.). As Rich is younger and only has an occasional palpitation (irregular heartbeat), mitral valve repair surgery may be appropriate.
  • As the long-term durability of the MitraClip for younger patients is not known, Dr. Chikwe is leading the new PRIMARY Clinical Trial which is sponsored by the National Institutes of Health (NIH).  The PRIMARY clinical trial will compare transcatheter mitral valve repair procedures (e.g. MitraClip) to surgical mitral valve repairs.

 

Thanks to Rich & Dr. Chikwe!

Many thanks to Rich for asking me his question. And, a special thanks to Dr. Chikwe for taking time away from her busy practice to share her clinical experiences and research with our patient community!

Keep on tickin!
Adam

 

P.S. For the deaf and hard of hearing members of our patient community, I have provided a written transcript of this video below.

Adam Pick: Hi, everybody. It’s Adam with heartvalvesurgery.com, and today we’re answering your questions about the treatment of severe mitral regurgitation using surgical or transcatheter techniques. I am thrilled to be joined by Dr. Joanna Chikwe, who is the Chair of Cardiac Surgery at Cedars-Sinai Medical Center in Los Angeles, California. During her extraordinary career, Dr. Chikwe has performed thousands of cardiac procedures, including many heart valve repairs and heart valve replacements. Dr. Chikwe, you and I have known each other for many, many years. It is great to see you again. Thanks for being with us today.

Dr. Joanna Chikwe: Pleasure to be with you again today, Adam.

Adam Pick: Dr. Chikwe, we’re answering patient questions. Today we got a question from Rich, who is one of the superstars in our community. He asks, “I’m a 63-year-old male who competes in natural bodybuilding. Three years ago, I had a mechanical aortic valve replacement, and now I have severe mitral regurgitation with mild atrium dilation. I have only mild symptoms, such as an occasional palpitation. Can I get the mitral valve repaired with a robotic procedure, or is the MitraClip the protocol given my risk factor?”

Dr. Joanna Chikwe: That’s a really great question. Rich has a range of options, depending on what has caused his mitral valve regurgitation. The valve can be repaired if it’s a prolapsed valve. If it’s other causes of mitral valve regurgitation, it may be that a replacement is more appropriate. Then this third option that Rich has asked about, which is the MitraClip, might be an option, but I have to put some caveats in here. The first one is that right now, Rich only has palpitations, and something like the MitraClip, which is a less invasive way of repairing the mitral valve through a vein in your leg, is really only approved for sick patients who aren’t fit for surgery, that have really bad symptoms.

Adam Pick: Dr. Chikwe, got to ask you a follow-up. You mentioned about the use of the MitraClip only for frail, very sick, perhaps even inoperable patients. Why is that?

Dr. Joanna Chikwe: That’s a great question. The reason for that is that we haven’t been using this technology in patients that are younger or don’t have symptoms, so we don’t know what the long-term durability of the MitraClip is. We know that a good surgical repair in a degenerative valve will last you a lifetime, but we don’t know that’s the case with MitraClip. That’s actually one of the reasons for a really important trial which we are running, which is comparing MitraClip with surgery in patients with severe mitral regurgitation due to mitral valve prolapse.

Adam Pick: Dr. Chikwe, I’m sure patients are now wondering what is this clinical trial, and how might I learn more about it?

Dr. Joanna Chikwe: The name of the trial is PRIMARY. It’s a randomized trial that’s funded by the National Institute of Health. There are high-volume expert centers participating in it. You can find a list of those centers at the clinical trial’s website that you can access through heartvalvesurgery.com. When you go to one of those centers for your mitral consultation, ask your surgeon or your cardiologist, am I eligible to participate in the PRIMARY trial?

Adam Pick: Rich, I hope that helped you learn more about the possibility of a robotic surgical mitral valve repair, also about the MitraClip. Dr. Chikwe, thanks for sharing all about the PRIMARY trial – sounds very interesting. As always, thank you for taking time away from your very busy practice there at Cedars-Sinai in Los Angeles and sharing all these fascinating insights about the best and most appropriate care of mitral valve disease. Thanks so much.

Dr. Joanna Chikwe: Thank you very much, Adam – absolute pleasure to join you and the heartvalvesurgery.com community today.

Adam Pick: Hi, everybody, it’s Adam. I hope you enjoyed that video. Don’t forget, you can always subscribe to our YouTube channel, watch the next two educational videos coming up on your screen, or click the blue button to visit heartvalvesurgery.com.


Written by Adam Pick
- Patient & Website Founder

Adam Pick, Heart Valve Patient Advocate

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

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