Expert Alert: Robotic repair offers benefits for many patients with leaky mitral valve

ROCHESTER, Minn. ― During each human heartbeat, four valves in the heart open and close once, moving blood through the heart’s chambers. But in some people, the flaps of the mitral valve between the heart’s left atrium and left ventricle do not work like they should. The opening may become narrow, or more commonly, the flaps may prolapse and not line up properly.

In cases of mitral valve prolapse, the gap allows blood to flow backward into the heart, and that causes problems.

Richard Daly, M.D., a Mayo Clinic cardiovascular surgeon, explains that when mitral valve leakage is severe, oxygen-rich blood cannot move efficiently through the heart to the rest of the body, causing shortness of breath and fatigue. Advanced mitral valve disease progresses quickly and can lead to heart failure. People with less mitral backflow may not feel symptoms, but they are still at risk of heart failure and other complications, such as stroke, blood clots, atrial fibrillation and pulmonary hypertension.

If mitral disease is mild, doctors often suggest monitoring with regular evaluations and sometimes medication. However, for people with severe mitral valve regurgitation, including those without symptoms, surgery may be the best option.

Research has found that repairing the mitral valve earlier, before the disease progresses, can correct the valve’s structure and potentially protect the heart’s function to avoid needing a more complex valve replacement later or developing heart failure.

Dr. Daly says open-heart surgery and minimally invasive robotic surgery use the same technique to correct mitral valve leakage, but they access the heart in different ways. With the robotic procedure, surgeons do not cut through the breastbone or open the chest cavity. Instead, they make several incisions, each about an inch long. One surgeon works from a remote console and views the heart through a high-definition 3D video monitor to conduct the surgery. Each tiny movement of the surgeon’s hands at the console controls is precisely replicated by small robotic instruments moving inside the patient’s chest. At the bedside, another surgeon works with the first surgeon and performs some aspects of the surgery to make sure the procedure is performed safely and efficiently.

Mayo Clinic physicians have repaired more than 900 mitral valves using the robotic technique since 2008. More than half of all mitral valve repairs at Mayo are now performed robotically. Besides using smaller incisions, the minimally invasive procedure has a shorter hospital stay ― typically three days, compared to five or six days for an open-heart procedure. Patients usually recover stamina and energy quicker with robotic surgery, and are back to work and normal activities a few weeks sooner.

“I was skeptical at first because I practiced open-heart mitral valve repair for years, and robotic surgery requires learning a new technique,” Dr. Daly says. “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.”

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