Since cardiothoracic surgeon Michael Rosenbloom, MD, FACS, FACC, FACCP, joined Cooper in 2007, he and his team have performed more than 1,100 minimally invasive valve operations. Their level of specialization and expertise consistently results in excellent patient outcomes. The Cooper Cardiothoracic Surgery team also includes Frank W. Bowen III, MD, FACS and Richard Highbloom, MD, FACS. Recently, they were joined by Joseph A. Kuchler, MD and Pasquale A. Luciano, DO.
Over the last 20 years, mitral valve surgery has continued to evolve, and Cooper has remained at the forefront of advancements in surgical treatment options. “In the Delaware Valley, we are a regional leader in mitral valve surgery,” says Dr. Rosenbloom, who is Head of Cooper’s Division of Cardiothoracic Surgery and Co-Director of the Cooper Heart Institute. “Notably, there aren’t a lot of places in the country where mitral valve repair is regularly done, let alone focused on. We are one of those places.”
When treating patients with mitral valve disease, the goal is to fix their valve with a durable repair, as studies have shown that repairing a native valve is always more effective than replacing it with an artificial valve. However, there is recent evidence that suggests that in certain situations, valve replacement is preferable. Ultimately, the most appropriate treatment really comes down to evaluating the condition of the individual patient as to the likelihood of a good long-term result.
Rheumatic heart disease, once the leading cause of mitral stenosis and often regurgitation, is no longer as prevalent, thanks to antibiotics. Today, degenerative conditions, often with a hereditary component, are a frequent culprit. “Mitral valve regurgitation represents a spectrum of conditions related to connective tissue deficiency,” Dr. Rosenbloom says. “Rupture of chordae tendineae with leaflet prolapse can be fairly straightforward, but a more billowing valve that’s very abnormal is more challenging to repair.”
Leaking mitral valves can also result from cardiomyopathy, heart failure, and coronary artery disease. “While treatment doesn’t change the course of heart failure, symptoms generally improve, and sometimes there’s improved muscle function when valve competency is restored,” says Dr. Rosenbloom. “For patients with coronary artery disease who have had an MI that misaligns their mitral valve, recent data suggest that replacement is as good or is better than repair.”
When replacement is the suggested approach, there are two options: tissue valves or mechanical valves. “In younger patients, we typically recommend a mechanical valve because they are more permanent,” Dr. Rosenbloom says. “The downside of using a mechanical heart valve is that it requires taking warfarin for life. The FDA has not investigated or approved other anticoagulation strategies for this application.”
Tissue valves are not permanent, potentially lasting 10-15 years on average. Their advantage is that they do not require the patient to be on lifelong warfarin therapy. So for many patients, particularly older patients, this may be a more desirable option. In addition, when a tissue valve degenerates, it no longer mandates a reoperation since a replacement valve can now be delivered via catheter into an existing tissue valve. While this option formerly was applied in high-risk patients only, technology has now advanced to the point where we can expect to see this approach become commonplace within the next decade.
The bottom line is, when significant mitral valve disease is identified, current evidence suggests that it should be addressed.
“An important study recently published in JAMA showed that when patients are operated on soon after identifying a mitral valve issue, their survival short, medium, and long term is improved as compared to people operated upon later in the course of their disease. The risks/benefits favor early intervention, even if the patient is asymptomatic,” says Dr. Rosenbloom. “We urge physicians not to wait to refer a patient for evaluation. Even if the patient isn’t quite ready for mitral valve surgery, it is often comforting to meet the surgeon and better understand their condition and treatment options.”
To schedule an initial office appointment with a Cooper
cardiothoracic surgeon, patients may call 856.342.2141.