Mitral Valve Repair, Closed Method (Under the armpit)

In the Western countries like America or European countries, 85% of Mitral valve insufficiency are degenerative cases. In these countries rheumatic Mitral Valve problems are less(12%). Degenerative insufficiencies are generally arise out of mitral valve prolapse, rupture of chorda or papillary muscle, elongation, ring dilatation or even rupture of the valve. In our country and Asian-African countries, Mitral Insufficiency rate originating from Rheumatic Valve Diseases is 60-65%, as it is estimated. Rheumatic Cardiac Valve Diseases are generally depend on rheumatic fever in the early ages. These kinds of valve repairs are difficult comparing degenerative diseases as the valve itself is degenerated and it’s shape is changed.

Mitral valve blocks arterial blood to return to lungs however when there is Mitral Valve Insufficiency, arterial blood goes back to lungs again. There are 4 stages of Insufficiency. The first stage of Insufficiency is generally found by chance and it does not cause any complaint for the patient. If there is a 2^nd stage insufficiency, it should be followed with Echocardiography. 3^rd and 4^th stage insufficiencies should be treated as soon as possible. When medications do not respond to the treatment or when there is expansion in cardiac chambers or pulmonary hypertension, Mitral Valve should be immediately treated with the surgical method.

Society of Thoracic Surgeons (STS) publishes United States of America’s Cardiac Surgery Clinics’ total statistical results and numbers every year. Below table STS shows these numbers (last 8 years) comparing it to TOBB ETU University Hospital’s Cardiovascular Surgery Department numbers (last 8 years).

In this table, it is seen that Rheumatic Valve Disease is in the forefront. Rheumatic Mitral Insufficiency is only possible in the cases in which there is no obstruction.

You may see on the picture (on the right side) a degenerated Mitral Valve arising from Rheumatic disease which is nearly impossible to be treated. Normally Mitral Valve is a little bit thicker than onion membrane however it became thick and calcareous. This valve’s opening is highly limited and it is impossible to repair it, that’s why, it needs to be replaced. In Valve Replacement surgeries, mechanic (metal) or biological (pig, cattle, horse etc.) valves are used. When mechanic valves are used, life long use of Coumadin (Warfarin) is obligatory. Whereas when the biological valve is used, (if there is no arrhythmia) this medication is not obligatory to use. However, biological valves are not long-lasting like metal valves.

Advantages of Mitral Valve Repair

- Long term valve Infection (Endocardits) is nearly 0% through the post-operative period

- Post-operative life expectancy is longer

- Cardiac functions are long-term protected

- Pulmonary Hypertension risk is lower in the long-term

- Paralysis risk is lower in the long-term though the post-operative period

- There is no need to take blood thinner medications

Mitral Valve Repair through Armpit with Small Incision

Mitral Valve Repair can be performed under right chest with 4-5 cm. small incision through endoscopic method (not necessarily used). In this method, there is no cutting bones, that is why there are some doctors who claim that it gives less pain. There are nearly no surgical or bone infections. As it is cosmetically more advantageous, patients are feeling more positive after the surgery and they turn back to their normal lives easlily.

Resources

1) Gammie JS, et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2009 May;87(5):1431-7Ann Thorac Surg 2009 May;87(5):1431-7

2) Aybek T. Mitral Valve Surgery; from median sternotomy to closed chest procedures, from replacement to repair techniques/clinical outcomes of mitral valve repair in mitral regurgitation. Anadolu Kardiyol Derg. 2011 Dec;11(8):745-