Minimally-Invasive Mitral Valve Surgery: Which Patients Are Candidates?

Video Transcript:

Adam Pick: Hi, everybody. It's Adam with HeartValveSurgery.com, and we're at the American Association for Thoracic Surgery Conference in Chicago, Illinois. I'm thrilled to be joined by Dr. Kenan Yount, who is a leading cardiac surgeon at the Mayo Clinic in Jacksonville, Florida.

Dr. Yount, it is great to see you, and thanks for being with me today.

Dr. Kenan Yount: Thanks for having me.

Adam Pick: We are here at AATS. There's a lot of presentations and talks and learning going on about valve disease. We're also getting questions from patients all over the world, and this one comes in from Kelly, and she asks, "Hi, Adam.

I have moderate mitral regurgitation. I'm confused about when a sternotomy or minimally invasive technique can be used for a repair or replacement. When can surgeons use less invasive techniques?"

Dr. Kenan Yount: Well, that is a great question. Uh, a- and first off, it's great that, that our patient knows that she has moderate mitral regurgitation, because sometimes patients let it get to severe or till they're symptomatic and heart failure.

We're in a great spot for somebody with moderate mitral regurgitation. Um, so first things first is to figure out somebody's symptoms and if it's affecting them, and maybe get some more tests to confirm it's moderate and not severe. sometimes that's a different type of echo, which is an ultrasound of your heart.

Sometimes that's a MRI to better quantify the mitral regurgitation, or a stress test to see whether or not the regurgitation may be more severe. If it is severe, then there are a couple different options. Minimally invasive is about what 90% of people come to me wanting. The good news is most people, most patients are candidates for it.

I probably think about it more in terms of who isn't a good candidate for a minimally invasive approach. A lot of times it has to do if somebody has multiple valve disease, so say an aortic valve problem on top of a mitral problem, or they have coronary blockages that are found during their workup, a- and that tends to be something that we can't manage minimally invasively on of a mitral valve operation as well.

And probably the last reason not to do minimally invasive surgery on someone would be if they have blockages in their legs, um, y- you know, oftentimes it's part of peripheral vascular disease, poor blood, poor circulation in the legs or arms, or a high risk of stroke. Those would be the kind of patients who you don't want to do a minimally invasive operation on.

But I'd say about 90% of patients tend to be good candidates for a minimally invasive operation.

Adam Pick: Fantastic. And when you say a minimally invasive operation, can that apply for both repair and replacement?

Dr. Kenan Yount: Ab- absolutely. You can do both a repair and a replacement through a, a minimally invasive approach through the side.

Also you can frequently do some sort of ablation through the side, as well as, uh, ligation of the atrial appendage. So atrial fibrillation (AFib) is a question I get a lot of, you know, can you also do mitral valve surgery in the setting of AFib? And, and the answer is yes, but it depends on the extent of the AFib, the extent of someone's heart function, and things like that.

Adam Pick: Dr. Yount, thanks so much. And Kelly, I hope that helped you. I know it helped me learn more. And Dr. Yount, on behalf of Kelly and the patients in our community at heartvalvesurgery.com, patients all over the world, thanks for everything you and your team are doing at Mayo Clinic in Jacksonville, Florida.

Thanks for being with me today.

Dr. Kenan Yount: Thanks for having me. Total pleasure, and I appreciate all the work y'all are doing to educate patients. It's a great mission.