Mitral Valve Repair: Is Open Chest or Robotic Surgery Better?
Written By: Adam Pick, Patient Advocate & Author
Medical Expert: Arnar Geirsson, MD, Chief of Cardiac Surgery, Yale New Haven Hospital
Published: October 6, 2022
I just received a very interesting question about the surgical approaches to mitral valve repair. Jane asked me, “Hi Adam – Is open chest or robotic surgery better for mitral valve repair?”
To provide Jane an expert opinion, I connected with Dr. Arnar Geirsson, Chief of Cardiac Surgery at Yale New Haven Hospital. Dr. Geirsson is a mitral valve repair specialist and Yale New Haven Hospital is a recipient of the Mitral Valve Repair Reference Center Award for the past three years.
Key Learnings About Mitral Valve Repair
Here are the important points I learned during my interview with Dr. Geirsson:
- Dr. Geirsson spent the early part of his career researching the different reasons why people develop mitral valve prolapse and mitral regurgitation (a leaking heart valve).
- According to Dr. Geirsson, it is very difficult to prove which approach to mitral valve repair – open chest surgery or robotic surgery – is better for the long-term treatment of mitral regurgitation. “It’s really difficult to prove which one is better than the other,” states Dr. Geirsson.
- There are two considerations to evaluate open chest and robotic mitral valve repair. “You have to look at two different things,” states Dr. Geirsson. “First of all, the invasiveness of the procedure, how stressful is it on the patient and the body. Most people do argue if you do a robotic repair or a robotic approach, that is less invasive, less trauma to the patient, smaller incision.” As for the second consideration, Dr. Geirsson states, “The second part to really think about is can you get the same results how you repair the valve, durability of the repair, if you do robotically or open.”
- A key factor that Dr. Geirsson identifies for getting an optimal surgical outcome is finding a mitral valve specialist. “I think if you go to a specialist who does a lot of either approach – whether that’s open or robotic – you’re going to get good results. Most important is to find the right surgeon who knows how to actually repair the mitral valve.”
- Dr. Geirsson continues to evolve his approach to minimally-invasive, mitral valve repair using new robotic techniques.
- While the mean number of mitral valve repair surgeries performed annually by cardiac surgeons is five, according to The Society of Thoracic Surgeons, Dr. Geirsson suggests that high-volume surgeons typically perform 40-to-50 mitral valve repairs each year.
- As for his advice, Dr. Geirsson suggests that patients should research potential cardiac surgeons and medical teams that they trust, have a good track record, and will provide a durable mitral repair with minimal residue regurgitation.
Many Thanks to Dr. Geirsson and Yale New Haven Hospital
On behalf of the patients at HeartValveSurgery.com, many thanks to Dr. Arnar Geirsson for sharing his clinical experiences and research with our community. We would also like to thank Yale New Haven Hospital for taking such great care of heart valve patients.
Keep on tickin!
Adam
P.S. For the deaf and hard of hearing members of our community, I have provided a written transcript of my interview with Dr. Geirsson below.
Written by Adam Pick
- Patient & Website Founder
Video Transcript:
Adam Pick: Hi, everybody. It’s Adam at heartvalvesurgery.com. Today we’re answering your questions all about open chest and robotic mitral valve repair surgery. I am thrilled to be joined by Dr. Arnar Geirsson, who is the Chief of Cardiac Surgery at Yale New Haven Health in New Haven, Connecticut. The Heart and Vascular Center at Yale New Haven Hospital has received the Mitral Valve Repair Reference Center Award for the past three years. During his extraordinary career, Dr. Geirsson has performed thousands of cardiac procedures, with many including mitral valve repairs. Dr. Geirsson, it is great to see you again. Thanks for being with us today.
Dr. Arnar Geirsson: Thanks, Adam. I really appreciate you inviting me here. It’s a real pleasure to be part of the heart valve surgery community.
Adam Pick: We’re going to get all to the patient’s question quickly here, Dr. Geirsson, but first, I’m curious to know – there are so many unique specialties in cardiac surgery. Why did you choose to focus on mitral valve repair?
Dr. Arnar Geirsson: That’s a great question. Early on in my career and training, I have a lot of interest in actually why people develop mitral valve prolapse and mitral regurgitation. I spent a fair time with that. Early, during my training and during my career, when you start doing these operations, repairing the mitral valve, I first of all found it challenging actually. It was also very gratifying when you can actually repair the valve and get good results. When you’re able to help patients to get good results, you prolong their life and improve their symptoms. I think that’s a really gratifying part of being a cardiac surgeon.
Adam Pick: Dr. Geirsson, I love how you have taken the research, taken the challenge of mitral valve repair, to help patients over their lifetime. Now we’ve got a really great question from Jane. She asks, “Is open chest surgery or robotic surgery better for mitral valve repair?”
Dr. Arnar Geirsson: That’s another great question. I think first of all, it’s really difficult to prove which one is better than the other. I think you have to look at two different things, first of all, the invasiveness of the procedure, how stressful is it on the patient and the body. Most people do argue if you do a robotic repair or a robotic approach, that is less invasive, less trauma to the patient, smaller incision, stuff like that. The second part to really think about is can you get the same results how you repair the valve, durability of the repair, if you do robotically or open. I think if you go to a specialist who does a lot of either one, whether that’s open or robotic, you’re going to get good results. You’re going to get good repair. That’s really what’s most important. I think once you’ve mastered either techniques, there’s really no difference or it’s really difficult to prove that it’s one approach better than the other. Most important is to find the right surgeon, the right person who knows how to actually repair the mitral valve.
Adam Pick: Dr. Geirsson, fantastic points. I hope the patients really listen to everything you just said. I’ve got to ask – you’ve been doing this now for – how long have you been repairing mitral valves for?
Dr. Arnar Geirsson: I’ve been doing this for about 15 years at least, I would say, as a busy mitral valve surgeon doing now close to over 100 repairs a year.
Adam Pick: For patients who may not know this, the average number – and check me if I’m wrong about this, Dr. Geirsson – of mitral valve surgeries done by a physician on any given year or in the SPS is only about five. Dr. Geirsson, I can’t thank you enough for helping so many patients there at Yale New Haven Health. I’ve got to ask you – you’ve been doing this for so long. How has your approach to repairing the mitral valve evolved or changed over time?
Dr. Arnar Geirsson: Over the last few years, I’ve certainly evolved to doing less invasive approaches to the mitral valve, doing the robotic mitral valve repair. I think that’s one way that my practice has evolved. The other thing that has changed, I think – and this happens when you become a busy mitral valve surgeon – you start to repair the valve a little bit differently. There are certain techniques that are a little bit more advanced than others. You certainly become more successful repairing the valve. There’s no doubt once you reach that level of being a high-volume surgeon – I’ve noticed that in myself in my career – when you really start to doing these 40, 50 repairs a year, that’s when you really start to become good at it. You can see that. I know that’s the way with most busy mitral valve surgeons, that they’re able to repair almost all the mitral valves that had mitral valve prolapse, that are considered to be reparable.
Adam Pick: Dr. Geirsson, given all of your incredible experience repairing mitral valves, I’m sure patients are wondering, what is your number one piece of advice for someone who is considering a mitral valve repair?
Dr. Arnar Geirsson: I think the most important thing to do is when you’re selecting a site or a surgeon to repair your mitral valve is really to ensure that you have a good, durable repair and good results, essentially having really minimal residual regurgitation at the end of the operation. There are certainly plenty of surgeons at plenty of hospitals throughout the US to do a lot of mitral valve surgery. Select the place that does a fair amount of it, has proven track record of providing good care and good outcomes through mitral valve repairs. Obviously, you want to select a surgeon or a hospital you’re comfortable with, somebody you feel like you connect with that person and you think you’re going to trust them to repair your valve.
Adam Pick: Dr. Geirsson, that is fantastic advice. On behalf of all the patients at heartvalvesurgery.com and all the patients who are watching this video all over the world, I want to thank you for taking time away from your very busy practice there at Yale New Haven Health in New Haven, Connecticut, and sharing all these great insights with our community. Thanks for being with us.
Dr. Arnar Geirsson: Thanks, Adam. I really appreciate being invited here. I’m really happy I could contribute to all the patients with valve disease.
Adam Pick: Hi, everybody. It’s Adam. I hope you enjoyed that video. Don’t forget, you can always subscribe to our YouTube channel, watch the next two educational videos coming up on your screen, or click the blue button to visit heartvalvesurgery.com.
