Robotic Repair of Leaky Mitral Valve Has Certain Advantages Over Open-Heart Surgery, Mayo Clinic Surgeon Says

Minimal incisions, shorter hospital stays, and faster recovery are some of the advantages of robotic heart surgery to repair a leaky mitral valve — a risk factor for pulmonary hypertension (PH) — compared to conventional open-heart surgery, says a cardiovascular surgeon at the Mayo Clinic.

Patients with a leaky mitral valve — the valve between the two chambers in the left side of the heart — may not feel symptoms, but they are at increased risk for heart failure and other cardiovascular complications, including PH (in this case the disease is called secondary PH), blood clots, and stroke.

Defects in the mitral valve impair the pumping of blood. When the valve fails to close properly, the blood can flow back, a condition called regurgitation. In these cases, blood carrying oxygen fails to move efficiently from the heart to the rest of the body, causing shortness of breath and fatigue.

People with a somewhat functional mitral valve are usually prescribed medications, and are regularly followed by a doctor, but they do not require surgical intervention. In more severe cases, however, mitral valve disease progresses quickly, and surgery is needed.

Repairing the valve’s defects as soon as possible is important. In fact, studies have shown that early intervention, before the disease progresses, can correct the valve’s structure to maintain the heart’s function and reduce the need for more complex valve replacement surgeries in the future.

However, there is a risk of death after undergoing traditional surgery to repair the heart’s mitral valve, and this risk is known to be higher in patients with PH.

At the Mayo Clinic, cardiovascular surgeons are using minimally invasive robotic surgery to correct mitral valve leakage. The surgery uses the same technique as conventional open-heart surgery, but differs in how it accesses the heart.

“I was skeptical at first because I practiced open-heart mitral valve repair for years, and robotic surgery requires learning a new technique,” Richard Daly, MD, said in a press release. “But now I feel that, for the right patients, robotic repair is clearly superior, with better visibility and equal movement of hands. I think this is quite an advance.”

In robotic surgery, surgeons make several incisions about an inch long instead of cutting through the breastbone or opening the chest cavity. One surgeon then operates a remote console, and uses a high-quality 3D video monitor to conduct the surgery.

The movements of the surgeon are mimicked with precision by the small robotic instruments inside the patient’s body. Meanwhile, at the patient’s bedside, a second surgeon evaluates the robot’s performance, helping to make the surgery run effectively and safely.

Since 2008, Mayo Clinic surgeons have used robotic surgery to repair more than 900 mitral valves. The procedure is now performed in more than half of the heart surgeries at the clinic.

Besides being a minimally invasive procedure, robotic surgery shortens hospital stays to three days from the five or six days required for open-heart surgery, according to the clinic. Also, patients who undergo robotic surgery recover faster, and return to their work and normal life sooner.