Dr. Aklog describes the treatment options for mitral valve disease/MVD.
As with other valves, there really are two main categories of treatments of diseased mitral valves – repair and replacement. However, with mitral valve disease, it’s really important to understand the benefits of valve repair because the majority of patients with leaking mitral valves in particular, especially if its from degenerative conditions where the valve is degenerated, are candidates for mitral valve repair.
Mitral valve repair involves taking the patient’s own valve and reconstructing it in such a way that it can now work. It’s almost like plastic surgery of the mitral valve, but you retain your own valve. It typically involves an addition, the implantation of a ring, that reshapes the outer part of the valve, but still at the end of the day, it’s your own valve that’s actually opening and closing and forming a seal.
Mitral valve repair is more difficult, a little bit more technically challenging than valve replacement where you simply remove a portion or all of the patient’s diseased valve and replace it with either an animal tissue valve or a mechanical valve. Because mitral valve repair is more technically challenging, it’s under-utilized.
So there are many patients around the country who would benefit from a valve repair, who unfortunately are not getting it, and the national figures would indicate that about 40 to 50% of patients, at most, who were candidates for valve repair, are actually getting valve repair. At the centers of excellence that do a lot of mitral valve repair surgery, the repair rates are 90-95% plus. So that becomes a very critical issue.
So a patient with a leaky mitral valve merely needs to become very informed about what the options are and insist, to be frank, that their doctor identify or to identify themselves a center that is highly experienced in the technical nuances of mitral valve repair.
Why is mitral valve repair so much better than valve replacement? Again, it’s because your own valve is always going to function better than a valve that’s created either from animal tissue or a mechanical valve, and the data on that is very clear. Patients who get mitral valve repair have enormous benefits in the short-term as well as in the long-term. The risk of the surgery is actually lower. The overall heart function is better preserved, and at the end of the day, patients who get valve repair simply live longer than patients who get a valve replacement.
And the final benefit is that they don’t have the disadvantages of having these imperfect valve replacement devices that we have. So they don’t have to take blood thinners typically, and they’re not exposed to the wear and tear that can occur on an animal valve that would require another operation down the road. So really with mitral valve disease, particularly leaky mitral valves, the key issue is identifying if you’re a candidate for a valve repair, and if you are, being at a center that is skilled and experienced at giving you the greatest chance of getting it repaired.
About Dr. Aklog, M.D.:
Dr. Lishan Aklog is the current Director and Chief of Cardiovascular Surgery at The Heart and Lung Institute of St. Joseph’s Hospital and Medical Center in Phoenix, Arizona and Director of EmpowHer's Medical Advisory Board. Specializing in adult cardiac care, he graduated from Harvard College followed by Harvard Medical School. Dr. Aklog was a cardiothoracic resident at Brigham and Women’s/Boston Children’s Hospital, an Associate Chief of Cardiac Surgery at Mount Sinai Medical Center in New York, and completed international fellowships in London, England and Paris, France.
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