Life Is Good After Complex, Robotic Mitral Valve Repair

LOS ANGELES (Feb. 28, 2023) — Elizabeth Hinlein is freshly home from three weeks in Italy. The streets of Venice, Florence, Rome and Siena inspired her creative work as an artist and filmmaker, and also helped her regain her strength and build back her stamina.

And count her lucky stars.

Just three months ago, the lifelong fitness enthusiast and avid runner was in the operating room at Cedars-Sinai, undergoing robotic mitral valve repair—a minimally invasive, yet complex, surgery.

Hinlein had been shocked to learn that she needed it.

“I had no signs that anything was wrong with my heart,” Hinlein said. “It was completely out of the blue.”

At a routine doctor’s appointment in May 2022—her first since the start of the pandemic—Hinlein’s general practioner listened to her heart and asked her if anyone had ever told her that she had a heart murmur. No, she said. The doctor referred her to a cardiologist for an echocardiogram, and from there she was quickly referred to a cardiac surgeon.

Hinlein’s diagnosis was severe mitral valve regurgitation—a type of heart valve disease that occurs when the mitral valve, which regulates blood flow from the heart’s left atrium into the left ventricle, does not close properly and allows blood to flow backward through the valve.

It can cause breathlessness, chest discomfort, palpitations and fatigue—or in Hinlein’s case, no symptoms at all.

She would need surgery within six months to fix the leaky valve, which, if left untreated, can lead to heart failure, heart attack or even death.

Joanna Chikwe, MD, professor and chair of the Department of Cardiac Surgery in the Smidt Heart Institute at Cedars-Sinai, performed Hinlein’s surgery. She said that roughly one-third of the patients she sees with mitral valve regurgitation do not have symptoms.

“Elizabeth was running three days a week for 45 minutes at a time,” Chikwe said. “This really underlines the importance of getting regular, thorough checkups and getting connected with the right specialist if something turns up. And of course, if you feel that something isn’t right with your heart, see your doctor.”

Chikwe, the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery, said that Hinlein’s valve disease had likely been developing for some time and that research is underway to better understand why it develops, whether genetics plays a role, and more.

When Hinlein, who is bicoastal, learned that she would need mitral valve repair surgery, she immediately began researching medical care in both Los Angeles and New York City.

“I was very circumspective about the process,” Hinlein said, adding that when she met with Chikwe, she knew her search was over.

“Dr. Chikwe was amazing,” she said. “By far the best listener, empathetic, very grounded—and she really loves the heart, you could just see that.”

Pioneering Excellence

The Smidt Heart Institute is ranked #1 in California and #3 in the nation for Cardiology and Heart Surgery in U.S. News & World Report’s “Best Hospitals 2022-2023” rankings. Smidt surgeons perform more robotic and transcatheter valve repairs than most other program in the U.S. The more than 1,500 robotic mitral valve repair procedures they’ve performed have resulted in a near 100% success rate.

The Smidt Heart Institute has been named a Mitral Valve Repair Reference Center by the American Heart Association and the Mitral Foundation, a recognition awarded to select U.S. medical centers that have a record of superior clinical outcomes resulting from evidence-based, guideline-directed degenerative mitral valve repair. And, since 2017, the Smidt Heart Institute has received the highest national ratings for mitral valve surgery from the Society of Thoracic Surgeons. 

Historically, heart surgeons corrected a faulty mitral valve by replacing it with an artificial one via open-heart surgery. Today, specialists are able to repair, rather than replace, the valve through minimally invasive surgery.

But Chikwe, widely recognized for her skill in robotic and minimally invasive surgical techniques, said that between 20% and 30% of patients nationwide with severe mitral valve regurgitation have their valve replaced, instead of repaired.

“Repair is the gold standard,” Chikwe said. “Patients who keep their own valves have faster recovery times as well as the best length and quality of life.” 

More than 95% of patients who had robotic mitral valve repair at Cedars-Sinai were alive and well with intact repairs five years later, according to research Chikwe shared, published in The Journal of Thoracic and Cardiovascular Surgery. And although the surgery is complex, she said, it is remarkably safe (the risk of mortality is 0.3%, according to research published in the Annals of Thoracic Surgery) and an “everyday surgery” for the Smidt Heart Institute team.

“It’s not only the surgeon’s experience that matters—it’s the experience of the nursing team, the anesthesia team, the operating team—everyone coming together to make this surgery safe and effective,” Chikwe said. “Doing the minimally invasive surgery robotically adds a layer of complexity, which is the reason that patients like Elizabeth seek out expert teams.”

Chikwe is the principal investigator for a multicenter, multicountry trial—the PRIMARY clinical trial—which is currently recruiting patients and will compare the surgical approach for valve repair with the transcatheter edge-to-edge (using a clip) approach.The trial is funded by the National Institutes of Health and will inform treatment selection for future patients.

Positive Outcome—and Outlook

Hinlein was in the hospital for about a week after surgery and she continues to see a cardiologist for follow-up visits.

She’s started running again—short stretches for now, but said she expects to feel back to 100% in just a few more months. Chikwe does not expect Hinlein to need additional mitral valve procedures.

Hinlein gives credit to Cedars-Sinai for her good outcome.

“Life is good,” she said. “I couldn’t be happier with how everything turned out.”

Read more on the Cedars-Sinai Blog: Treatment Options for Heart Valve Disease