Surgeon Q&A: Is Robotic Mitral Valve Re-Repair Possible?

The utility of robotic mitral valve repair techniques may be advantageous for the right patient at the right cardiac center. A shorter hospital stay, faster recovery, less blood loss, smaller incision, and significantly less pain make robotic surgery an interesting choice for many patients compared to a traditional sternotomy approach. In the past, only the most straightforward cases of mitral valve disease were considered suitable for robotic repair.

Now, however, even cases with complex mitral valve disease are often eligible for a robotic approach. But what about those patients who’ve already had a mitral valve repair and then learn that their valve is leaking again? Will they be able to have their valve re-repaired robotically? It is an interesting question for many patients in our community who need a re-operation and want to know if robotic surgery is an option for them.

To learn more about robotic mitral valve re-repair and patient candidacy, HeartValveSurgery.com’s founder, Adam Pick, spoke with Dr. Marc Gillinov, Chairman of Cardiac Surgery at the Cleveland Clinic in Cleveland, Ohio. Dr. Gillinov specializes in robotic surgery and, according to the Cleveland Clinic, performs more mitral valve surgeries each year than any other surgeon worldwide.

Mitral Valve Re-Repair and Who Is Eligible for a Robotic Approach

Here are the key insights shared by Dr. Gillinov:

• How many robotic-assisted mitral valve surgeries have you done at the Cleveland Clinic? “We’ve done a lot,” said Dr. Gillinov. “The robotic-assisted repair is really cool because you have a little incision on the side, and we can fix your valve. We’ve done 2,600 mitral valve repairs with the robot, and the results are really good. We keep track of the results very carefully, and the risk is under one in a thousand with a repair rate of more than 99 percent. So, very good in the right patients. What’s cool to me is that, in addition to the fact that the heart looks great and the echo is just right, the day after surgery, people don’t look like they’ve gone through much. They look like normal people, not someone recovering from heart surgery, but just people who had a little operation.”

• Given the lifetime management of valve disease, patients may need a re-repair. Can a robot be used to re-repair the mitral valve? “The short answer to that question is yes, but it depends. It would be very difficult if someone had a robotic repair initially to go back through the right side because of scar tissue. On the other hand, if someone initially had a sternal approach with a regular incision, it’s not that hard to go back through the right side. So, it depends on the patient’s previous approach and the CT scan results. The real question for the patient is where they will get the safest, best operation with the lowest risk and highest chance of re-repair. If we can deliver the low risk with the highest chance of re-repair with the robot, then we will definitely do it.”

• What is it about having the initial repair done robotically that makes going in with the same approach for a re-repair more challenging? “The main problem is scar tissue,” said Dr. Gillinov. “When you’ve had a previous incision on the right side of the chest, the lung can become fused to the chest wall. You don’t feel anything with that, and you can’t see it on a CT scan, but if we go back in on that side, we might encounter the lung stuck to the chest wall. We then have to dissect the lung off the chest wall, which often requires us to make a bigger incision.” Dr. Gillinov explained that when this happens, a small incision can become a much larger one, making the operation more complicated and increasing the risk to the lung, compared to opting for a sternotomy instead, which would make the surgery far less involved. Dr. Gillinov continued, “Conversely, if you had your first operation through the front and it’s just a mitral valve operation, we could go through the side. So, you want to go where you haven’t been previously and take the road less traveled in the first operation.”

Thanks Dr. Gillinov and Cleveland Clinic!

On behalf of all the patients in our community, thank you, Dr. Marc Gillinov, for everything you and your team are doing at the Cleveland Clinic in Cleveland, Ohio!

Related links:

• See 100+ Patient Reviews for Dr. Gillinov’s Interactive Surgeon Profile
• Surgeon Q&A: 3 Facts to Dispel Patient Anxiety Before Heart Surgery

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Gillinov below.