How Early Surgery Might Help Some Heart Patients

Degenerative mitral valve regurgitation patients who need surgery may benefit more from early intervention

(RxWiki News) If your ticker has a leaky valve, it may be better to be an early bird when it comes to surgery.

A new study from the Cleveland Clinic found that treatment using earlier surgery and less invasive techniques may be more helpful to patients with degenerative mitral valve disease.

“Surgery is almost unavoidable in patients with severe degenerative mitral valve regurgitation," said study author Farhang Yazdchi, MD, a clinical fellow in cardiac surgery at Brigham and Women’s Hospital at Harvard Medical School, in a press release. "Our study has shown that the key to successful treatment is a timely referral for surgical intervention at an advanced repair center with highly skilled heart teams."

The heart's mitral valve allows the blood — which is flowing in from the lungs — to flow into the next heart chamber (ventricle). If the mitral valve doesn’t work well, blood can back up in the lungs and cause heart failure.

Usually, this leads to blood leaking backward through the valve — known as regurgitation. Degenerative mitral valve regurgitation is irreversible. Surgery is required to repair the valve.

At one time, doctors tended to wait as long as possible to perform mitral valve surgery because it was so risky. However, this surgery can be much less invasive today.

Dr. Yazdchi and team looked at data — over a 25-year period — on almost 6,000 patients from the Cleveland Clinic. They looked for trends in these patients' treatment, such as the timing of their surgery and the types of surgical techniques used.

Surgical techniques used at the start of the 25-year period were highly invasive. Patients often required a full open-heart surgery with a large chest incision.

However, by the end of that period, doctors tended to use robotic surgery — which is much less invasive. Patients were often released from the hospital about two days earlier.

Dr. Yazdchi and team found that the newer surgeries were also much less risky and had a very low death rate.

Dr. Yazdchi and team said patients with severe mitral valve regurgitation should have surgery soon after they are diagnosed. According to researchers, this early surgery may prevent symptoms like atrial fibrillation — an irregular heartbeat that can cause blood clots and strokes.

“Successful mitral valve repair at the Cleveland Clinic has reached a level of almost 100%, while mortality rates have remained extremely low and hospital length of stay shortened,” Dr. Yazdchi said. “Patients who are diagnosed with severe mitral valve regurgitation should seek surgical consultation sooner rather than later, even if they are not having any symptoms."

This study was published in the June issue of the journal The Annals of Thoracic Surgery.

The Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery (held by study author Dr. Joseph F. Sabik III) and the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (held by study author Dr. Eugene H. Blackstone) funded this research.

Study author Dr. Yazdchi was a National Heart, Lung and Blood Institute Clinical Research Scholar of the Cardiothoracic Surgical Trials Network. His MS was funded by the National Institutes of Health.

Study author Dr. Marc Gillinov, MD, disclosed financial ties with Edwards Lifesciences, Medtronic, On-X, Abbott, Tendyne and St Jude. Dr. Sabik disclosed ties with Medtronic, Sorin, Edwards Lifesciences and Abbott. These companies make drugs or equipment used in treating heart disease.

Review Date: 
June 2, 2015