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Mitral Valve Awareness: Top 5 Considerations for Mitral Valve Surgery Patients

Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Experts: Michael Acker, MD, Chief, Division of Cardiovascular Surgery; Michael Ibrahim, MD, Director, Mitral and Reconstructive Valve Surgery, at Penn Medicine
Published: April 12, 2023

When patients learn they need mitral valve surgery, patients may become confused about their surgical options, timing the procedure, selecting their medical team, and developing a lifelong plan for the management of mitral valve disease.

During Mitral Valve Disease Awareness Week, we want to help patients better understand the important considerations for mitral valve therapy. For that reason, I hosted a “Surgeon Roundtable” with Dr. Michael Acker and Dr. Michael Ibrahim, two leading mitral valve surgeons from Penn Medicine Heart and Vascular Center in Philadelphia, Pennsylvania.

Key Considerations About Mitral Valve Surgery

Here are important considerations for patients shared by Dr. Acker and Dr. Ibrahim about mitral valve therapy:

Consideration #1: It is advisable for patients who do not have symptoms (asymptomatic) to proceed with mitral valve surgery to prevent cardiac damage. Dr. Acker states, “We want to operate when your heart is strong. Mitral valve disease leads to the deterioration of your cardiac condition. That can be obvious heart failure, pulmonary hypertension, and atrial fibrillation.”

Dr. Michael Acker

Consideration #2: Mitral valve repair is the preferred surgical approach for patients with mitral valve disease. “When we repair a mitral valve, we’re restoring natural mitral valve structure, restoring the mitral valve to what it was when you were born,” states Dr. Ibrahim. “Mitral valve repair produces important clinical results like improved survival compared to replacement, improved valve performance, freedom from valve-related complications (blood clots on the valves, bleeding from blood thinners) and significant improvements in the length and quality of your life.”

Dr. Michael Ibrahim Dr. Michael Ibrahim

Consideration #3: Patients must research their potential surgeons and cardiac centers. “Mitral valve repair is done best in centers that have a lot of experience,” states Dr. Acker. “Data from the Society of Thoracic Surgeons (STS) suggests that the majority of heart surgeons across America actually do five operations on the mitral valve per year. That’s it. For maximum outcomes, the surgeon should do more than 25 to 30 mitral valve repairs a year. The hospital should have an experience of at least 75 mitral valve operations per year.”
Consideration #4: Patients should be involved with their medical team when planning their mitral valve therapy using a ‘shared decision making’ approach. “It’s really important that you have a heart team working for you,” states Dr. Acker. “Multidisciplinary points of view and expertise from a cardiologist, an echocardiographer, the surgeon, the anesthesiologist. Really, it’s all about that team coming up with shared decision-making about you.”
Consideration #5: Establish a long-term plan for the management of mitral valve disease that may include reoperations using transcatether techniques. “The key is to work with a specialist valve surgeon to come up with a plan that serves your needs over your lifetime,” states Dr. Ibrahim. “These transcatheter techniques can involve repair (e.g. MitraClip) or replacement in either previous full ring repairs or previous tissue valve replacements. They offer several advantages in the sense that they do not involve repeat incisions and open heart surgery but they have significant limitations.”

Keep Learning About Mitral Valve Disease

As part of Mitral Valve Disease Awareness Week, we’re sharing new information to educate you about the management and the treatment of mitral valve disease including:

Keep on tickin!
Adam

P.S. For the deaf and hard of hearing, I have provided a written transcript of the video with Drs. Acker and Ibrahim below:

Adam Pick: Hi, everybody, it’s Adam with heartvalvesurgery.com, and this is a special surgeon question-and-answer session all about the top five considerations for mitral valve surgery patients. I am thrilled to be joined by Dr. Michael Acker and Dr. Michael Ibrahim, two leading mitral valve surgeons from Penn Medicine in Philadelphia, Pennsylvania. During their extraordinary careers, Dr. Acker and Dr. Ibrahim have performed thousands of mitral valve operations, including mitral valve repairs and mitral valve replacements.

Hi, Dr. Acker, great to see you again.

Dr. Acker: Great to see you, Adam.

Adam Pick: Hey there, Dr. Ibrahim. Thanks so much for being with us today.

Dr. Ibrahim: Thanks for having us, Adam.

Adam Pick: Dr. Acker, the first consideration we want to talk about is all about symptoms. It’s often confusing for those patients who actually have no symptoms but have severe mitral valve disease. Is it advisable for patients who are asymptomatic to have mitral valve surgery?

Dr. Acker: In fact, Adam, it actually is. We’ve known now for I guess around 15 years that patients with severe mitral regurgitation do better with successful mitral valve repair than just following them without any intervention. What we know is that mitral valve regurgitation in someone who’s completely asymptomatic and with a normal heart at the beginning can go on to develop heart failure. It’s important that we operate when your heart is strong and not wait until it’s developed heart failure. With today’s techniques and with our known great outcomes in mitral valve repair, it is absolutely advisable for you to have mitral valve repair while asymptomatic prior to the development of symptoms.

Adam Pick: Dr. Acker, I got to ask this follow-up. What potential damage can be caused to the patient’s health if they wait too long to have surgery if they’re asymptomatic?

Dr. Acker: Severe mitral regurgitation does lead to deterioration of your cardiac condition. That can be obvious heart failure. It can be evidence of pulmonary hypertension. It can be the development of atrial fibrillation, and all these things can occur suddenly. You want to make sure that you have your mitral valve surgery before they happen.

Adam Pick; Dr. Ibrahim, for the second consideration, it can also be a little confusing for patients specific to surgical techniques, either a replacement or a repair for the mitral valve that’s diseased. I’m curious to know, why is mitral valve repair the preferred treatment for mitral regurgitation?

Dr. Ibrahim: For some patients who don’t have repairable valves, mitral valve replacement is a good option. When we repair a mitral valve, what we’re doing is restoring natural mitral valve structure, restoring the mitral valve to what it was when you were born, which is based on your own amazingly complex and sophisticated sets of cells that we cannot replicate with an artificial valve made in a factory. It produces important clinical results like improved survival compared to replacement, improve valve performance, and importantly, freedom from valve-related complications: blood clots on the valves, bleeding from blood thinners, and so on. If your valve is leaking and can be repaired, mitral valve repair is going to result in significant improvements in the length and quality of your life.

Adam Pick; Dr. Acker, back to you for the third consideration. Why is it important for patients to research their potential surgeons and cardiac surgeons?

Dr. Acker: It’s important because mitral valve repair is really a operation that’s done best in centers that have a lot of experience with mitral valve surgery. Data from the STS suggests that the majority of heart surgeons across America actually do five operations on the mitral valve per year. That’s it. For maximum outcomes, the STS has also been queried and it’s actually the best outcomes for mortality, for survival, as well as to get a successful repair is if you find a surgeon and a center that do a lot. By that, I mean specifically the surgeon should do more than 25 to 30 mitral valve repairs a year. The center, the hospital, should have an experience of at least 75 mitral valve operations per year. That’s the way to assure you’re going to get a good repair and great outcomes.

Adam Pick: Dr. Acker, great points. Let’s move on to the fourth consideration, which is all about share decision-making. Why is it important for patients to work with not only their physician but the entire medical team when planning their operation?

Dr. Acker: It’s really important that you have a heart team working for you, one that has multidisciplinary points of view and expertise from a cardiologist, an echocardiographer, the surgeon, the anesthesiologist. Really, it’s all about that team coming up with shared decision-making about you, what’s best for you. That will assure good decisions and good outcomes.

Adam Pick: Dr. Acker, I really appreciate those comments. I’m curious to know, is it important for the patients to feel empowered, to ask questions to their potential surgeons about their treatment?

Dr. Acker: Great point, Adam. In the end, it is about you, and you must feel empowered to ask the hard questions, to do the research, to engage your surgeon as well as the multidisciplinary team, and make sure that it’s a good fit for you, that you feel comfortable. Absolutely the empowerment of the patient is paramount.

Adam Pick: Dr. Ibrahim, over to you for the fifth and final consideration, which chi what would patients know about the lifetime management of mitral valve disease?

Dr. Ibrahim: No, I think people are living longer. Patients with mitral valve disease can be young, and so the question comes up of how to manage their valve over a long period of time. I think what’s important is to sit down and form a plan for how to attack this disease over the course of your lifetime. That will correspond to your priorities you have at that point. For patient who is young, valve repair has several benefits in allowing superior valve performance and freedom from valve-related complications, for example, during pregnancy. Later on, the management of replacement valves may become relevant with tissue and mechanical options for the appropriate age patient. I think the key is to work with a specialist valve surgeon to come up with a plan that serves your needs over your lifetime.

Adam Pick: Dr. Ibrahim, I love the point about having a plan for the lifetime management of mitral valve disease. I’m sure patients are wondering about maybe some of the newer transcatheter techniques. What might patients want to know about transcatheter therapies for maybe their second or even third procedure?

Dr. Ibrahim: Yeah, this is a great point. It’s an area that is rapidly evolving. These transcatheter techniques can involve repair, i.e. mitral clip of previously surgically valves, or replacement in either previous full ring repairs or previous tissue valve replacements They offer several advantages in the sense that they do not involve repeat incisions and open heart surgery, BTU they have significant limitations. They are really available to patients who have specific anatomies. You should discuss this with your valve surgeon to come up with a conclusion as to whether this is something that will be beneficial to you or not.

Adam Pick; With those very important insights, we’re going to wrap up today’s session about the top five considerations for mitral valve surgery patients. Thanks for being here, Dr. Acker.

Dr. Acker: It’s been great speaking with you, Adam.

Adam Pick: Thanks, Dr. Ibrahim.

Dr. Ibrahim: Thank you, Adam.

Written by Adam Pick
- Patient & Website Founder

Written by Adam Pick - Patient & Website Founder

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.