Robotic Mitral Valve Repair Surgery: Insights, Outcomes & Patient Questions with Drs. Gillinov & Burns
Written By: Adam Pick, Patient Advocate & Author
Medical Experts: Marc Gillinov, MD, Chairman of the Department of Cardiothoracic Surgery, Cleveland Clinic, and Daniel Burns, MD, Minimally-Invasive Cardiac Surgeon, Cleveland Clinic
Published: June 16, 2022
Patient interest for robotic mitral valve repair surgery continues to grow. My inbox consistently receives patient questions including “What are the benefits of robotic mitral valve surgery?”, “Is robotic surgery better than a sternotomy?”, “Is the robot safe?”, and “Where can I find robotic mitral valve surgeons?”
For this reason, I was thrilled to learn that Dr. Marc Gillinov, the Chairman of the Department of Cardiothoracic Surgery at the Cleveland Clinic, and Dr. Daniel Burns, a minimally-invasive cardiac surgeon at the Cleveland Clinic, were going to answer important patient questions about robotic mitral valve repair surgery during a “roundtable” discussion filmed exclusively for our community.
Key Learnings About Robotic Mitral Valve Repair
Here are important educational highlights that I jotted down from this interview with Drs. Gillinov and Burns:
- Mitral valve repair surgery is superior to mitral valve replacement surgery for the treatment of mitral regurgitation (a leaky mitral valve) due to mitral valve prolapse. Patients who undergo mitral valve repair procedures typically (i) do not need blood thinners, (ii) do not need another mitral valve surgery and (iii) achieve a normal life expectancy.
- The Cleveland Clinic can repair 99% of regurgitant mitral valves due to prolapse. “We aim to repair the valve in people with mitral valve prolapse,” states Dr. Gillinov. “We can repair 99% of these valves and restore people to a normal quality of life.”
- Robotic mitral valve surgery can provide patients unique benefits including a minimally-invasive approach to heart. Compared to a traditional sternotomy, which can require a 6 to 8 inch incision to the breastbone, robot-assisted procedures utilize smaller incisions often less than 2 inches.
- When performed by a team of robotic specialists, the additional benefits of robot-assisted mitral valve repair surgery include less trauma to the body, less pain, shorter hospital stays (usually 3 to 4 days), decreased use of pain medications, less bleeding, decreased risk of infection, shorter recovery, and quicker return to daily and professional activities.
- Not all patients are candidates for robotic mitral valve repair surgery. Several different tests are performed by the Cleveland Clinic team to ensure patient safety. “When you come to the Cleveland Clinic, you’ll have an ultrasound of the heart, a CT scan, and a cardiac catheterization looking at the arteries to make sure (i) everything looks good and safe for a robotic operation, and (ii) that there’s nothing else that needs to be done that might take that possibility away. Once we have all the testing done and completed, we make our final decision with the primary goal of giving the best, safest operation for the patient.”
- Dr. Gillinov suggests that patients typically need to reflect on three important questions about robot-assisted mitral valve repair surgery. Those questions are “What is my risk?”, “What is the likelihood of a successful mitral valve repair?” and “Can this be done using minimally-invasive techniques including the robot?”
- The operative risk for mitral valve surgery at Cleveland Clinic is currently less than one in a thousand (0.1%), according to Dr. Gillinov.
- Patient safety is the ultimate consideration for Dr. Gillinov and Dr. Burns when deciding on whether-or-not the robot will be the best option to repair a patient’s leaky mitral valve. “Our goal has always been to offer the same operation in terms of quality, safety, and durability,” states Dr. Burns. “If any of those things aren’t going to match up, we won’t compromise the results just to do a minimally invasive operation.”
- Cleveland Clinic has performed over 2,100 robotic mitral valve operations with excellent patient outcomes. “Robotic mitral valve surgery is very much a specialty,” states Dr. Gillinov. “It is important for your robotic team to have experience because there is an extensive learning curve to robotic surgery. Thankfully, we completed that learning curve years ago. Patients leave Cleveland Clinic with an outstanding echocardiogram (meaning their valve is fixed) and a small incision on their chest. So, they look great and they don’t feel like they had much done.”
Thanks Dr. Gillinov, Dr. Burns & Cleveland Clinic!
On behalf of our entire patient community, many thanks to Dr. Gillinov and Dr. Burns for sharing their clinical experience and research with our community! Also, many thanks to Cleveland Clinic for taking such great care of heart valve patients.
- Robotically Assisted Mitral Valve Repair: Procedure Details, How It Works
- Recovery & Outlook After Robotically-Assisted Mitral Valve Repair
Keep on tickin!
P.S. For the deaf and hard of hearing members of our community, I have provided a written transcript of this interview below.
Dr. Gillinov: I’m Marc Gillinov, a cardiac surgeon at the Cleveland Clinic. My special area of interest is in robotic mitral valve repair surgery.
Dr. Burns: I’m Dr. Daniel Burns, cardiac surgeon at Cleveland Clinic, and specializing in robotic and minimally invasive mitral valve surgery.
Dr. Gillinov: When patients come to the Cleveland Clinic with mitral valve prolapse or degenerative mitral valve disease – those are two terms for the same thing – they have a leaking mitral valve. One of their key questions is, should I get a repair of my valve or a replacement? That gets to the concept that mitral valve repair is superior to mitral valve replacement in almost all patients who have mitral valve prolapse and a leaking mitral valve. People who get a mitral valve repair don’t have to take any anticoagulants or blood thinners and most often never need another cardiac surgical procedure or never need heart surgery again for the rest of their lives. They go back to a completely normal life. That’s the reason that we aim to repair the valve in people with mitral valve prolapse. We can repair 99% of these valves and restore people to a normal life and a normal quality of life.
Dr. Burns: Many times, when people seek out the Cleveland Clinic for their mitral valve repair operation, they seek it out because of the possibility of having it done with robotic assistance, so avoiding dividing the breastbone to get at the heart and the mitral valve. In most cases of isolated mitral valve disease because of prolapse, we can do this robotically, but there are a certain number of tests we have to get in order to determine whether or not the patient is going to be a minimally invasive candidate.
When you come to the Cleveland Clinic, you’ll have an ultrasound of the heart, a CT scan, and a cardiac catheterization looking at the arteries to make sure, one, everything looks good and safe for a robotic operation, and two, that there’s nothing else that needs to be done that might take that possibility away, making it a better option to go through the breastbone. Once we have all the testing done and completed, we make our final decision with the primary goal of giving the best, safest operation for the patient.
Dr. Gillinov: When people are thinking about their mitral valve surgery, they think about three different things in general, three different questions. First, what’s the risk – because you want the lowest risk operation possible. Second, what’s the likelihood of repairing my valve – because valve repair is better than valve replacement. Third, can I get this done robotically or minimally invasively, through a little incision like this instead of a standard incision?
It is most important to get a safe operation and to get a valve repair. Here at Cleveland Clinic, our operative risk for mitral valve surgery is less than one in a thousand. Our repair rate is more than 99%. Why do it robotically? If we can do your operation robotically, you’re going to have a quicker recovery. You can drive right away after leaving the hospital if you’re not on pain medicines. You can be more active more quickly. You’ll have a lower risk of needing a blood transfusion with robotic surgery, a lower risk of infection. Of course, cosmetically, it’s better. You don’t look like you had heart surgery. If we can deliver the same safety and the same effectiveness for an incision this big, that’s what we’re going to do for you.
Dr. Burns: Patients often question whether or not their valve repair is going to be as good if we do it robotically versus conventionally. Our goal has always been to offer the same operation in terms of quality, safety, and durability. If any of those things aren’t going to match up, we won’t compromise the results just to do a minimally invasive operation. Thankfully, regardless of whether it’s a conventional operation or a robotics-assisted operation, our repair rates when we set out to repair the valve are better than 99%.
Dr. Gillinov: Robotic mitral valve surgery is very much a specialty. It is important for your robotic team to have experience, because there is an extensive learning curve to robotic surgery. Thankfully, at Cleveland Clinic we completed that learning curve years ago. We’ve done more than 2,100 robotic mitral valve operations with exceptional results for our patients – patients traveling from across the country and around the world, leaving Cleveland with an outstanding echocardiogram, meaning their valve is fixed and a small incision on their chest, so that they look great and they don’t feel like they had much done.