Doctor Q&A: Minimally-Invasive Surgery for Secondary Mitral Valve Regurgitation
Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Arman Arghami, MD, Mayo Clinic, Rochester, Minnesota
Published: June 21, 2023
I just received a great patient question from Lee about minimally-invasive surgery for secondary mitral valve regurgitation. In his email, Lee asks, “Hi, Adam – I am under the impression that surgeons who use minimally-invasive techniques are treating primary mitral regurgitation. What is the suggested treatment when severe mitral regurgitation is secondary due to an enlarged atrium and there is also tricuspid regurgitation?”
To answer Lee’s question, I was very lucky to connect with Dr. Arman Arghami, a leading minimally-invasive cardiac surgeon and robotic mitral valve expert at Mayo Clinic in Rochester, Minnesota.
Key Learnings from Dr. Arghami
Here are several important learnings from Dr. Arghami:
- Dr. Arghami is using minimally-invasive robotic approaches for many different types of valvular disease and related cardiac disorders. “Robotics can be applied to almost any valve pathologies for treatment,” states Dr. Arghami. “We can even combine surgeries, like tricuspid valve repair, ASD closure, PFO closure, or a tumor inside the atrium. These can be all combined.”
- Specific to mitral valve disease, a key question for patients and their medical teams is whether-or-not the defective valve can be repaired or replaced. Doctor Arghami states, “The big question is whether the valve needs to be repaired or replaced. That comes down to the cause of the mitral valve regurgitation.”
- There are two types of mitral valve regurgitation.
- Primary mitral regurgitation, also known as structural mitral regurgitation, is a problem of the mitral valve leaflets.
- Secondary mitral regurgitation, also known as functional mitral regurgitation, relates to problems of the ventricle, the pumping chamber of the heart, or the atrium which may be enlarged or stretched out.
- According to Dr. Arghami, treatment varies based upon the type of mitral regurgitation a patient has. “With primary regurgitation, you can most of the time repair it,” states Dr. Arghami. “With secondary regurgitation, you have to consider replacement because the durability of repair may not be as good. That depends on the echocardiogram images, the history of the patient, and the function and shape of the ventricle. Nonetheless, they can all be applied and robotic surgery can be applied to these for a repair or a replacement.”
Many Thanks to Lee, Dr. Arghami & Mayo Clinic!
Many thanks to Lee for his excellent question! On behalf of our patient community, many thanks to Dr. Arman Arghami at Mayo Clinic Minnesota for taking the time to share his clinical research and experience with us.
Keep on tickin!
Adam
P.S. For the deaf and hard of hearing members of our community, I have provided a written transcript of our interview with Dr. Arghami below.
Written by Adam Pick
- Patient & Website Founder
Video Transcript:
Adam Pick: Hi, everybody. It’s Adam with heartvalvesurgery.com. Today, we’re at the Society of Thoracic Surgeons conference. I am thrilled to be joined by Dr. Arman Arghami who’s a leading mitral valve surgeon and the Male Clinic in Rochester, Minnesota. Dr. Arghami, thanks for being with me today.
Dr. Arghami: Thank you, Adam. It’s a pleasure to be here and among your community.
Adam Pick: Yeah, as you know, Dr. Arghami, today we are answering some patient questions that are coming in. One of them is for Lee. He asks, “Hi, Adam. I am under the impression that surgeons who use minimally invasive techniques are treating primary mitral regurgitation. What is the suggested treatment when severe mitral regurgitation is secondary due to an enlarged atrium and there is also tricuspid regurgitation?”
Dr. Arghami: Very good question, Adam. I like to focus on two aspects of this. One is the technique of treatment, whether it’s sternotomy or minimally invasive or robotic. Short answer to that is robotic can be applied to almost any valve pathologies for treatment. We can even combine surgeries, like tricuspid valve repair, ASD closure, PFO closure, or a tumor inside the atrium, these can be all combined. The bigger question is whether the valve needs to be repaired or replaced. That comes down to the cause of the mitral valve regurgitation.
Now, as mentioned in the question, there are two types, the primary or structural, which is the problem of the leaflet of the valve, or secondary or functional, which is the problem of the ventricle, the pumping chamber, or the atrium, which is enlarged and stretched out. With that in mind, the treatment differs. With the primary, you can most of the time repair it. With the secondary, you have to consider replacement because the durability of repair may not be as good. That depends on the echo images, the history of the patient, and the function and shape of the ventricle, but nonetheless, they can all be applied and robotic surgery can be applied to these for a repair or a replacement.
Adam Pick: Lee, I hope that helped you. I know it helped me learn a whole lot more. Dr. Arghami, again, on behalf of all the patients at heartvalvesurgery.com, patients all over the world, thanks for the great work you’re doing at Mayo Clinic.
