Mitral valve repair by experienced surgeons improves the survival rate of patients

Feature Article in New England Journal of Medicine Updates Surgical Options

Superior surgical techniques used in centres such as the University of Ottawa Heart Institute (UOHI) to fix a faulty heart valve flap, eliminate severe blood leakage and other serious cardiac conditions are highlighted as an expert guide to physicians and featured today in one of medicine's most prestigious journals.

The Heart Institute's specialties include heart valve surgery, particularly reconstruction of the mitral valve - the flap separating the heart's two chambers so blood can flow through the heart during a normal heart beat. A floppy mitral valve (called a prolapse) can cause blood to leak backwards and other complications, notably heart infection, enlarged heart and possibly heart failure.

Details of this medical problem and preferred surgical treatment appear today in a special feature in the New England Journal of Medicine (N Engl J Medicine 2009; 361:2261-69). The Heart Institute performs one of the largest volumes in North America - 150 cases - of mitral valve repair annually. This is an area of expertise for Dr. Thierry Mesana, Chief, Division of Cardiac Surgery, UOHI.

An estimated 2% per cent of the general population is affected by mitral valve prolapse. Until recently, valve replacement with biomaterial or a mechanical device was the preferred procedure. Now, larger cardiac surgery centres offer the superior skill necessary to smoothly perform this complex procedure.

"Cardiac surgery has undergone major transformation in recent years where skilled surgeons are increasingly engaged in reconstructive techniques that reduce the likelihood of coagulation problems, stroke and heart attack. Mitral valve repair in the hands of a skilled, experienced surgeon results in significant survival for patients, especially those with serious valve leakage," said Dr. Mesana.

Successful mitral valve repair might also enable the heart muscle to pump stronger than with an implanted mechanical valve, reducing risk of stroke and eliminating use of anticoagulants or blood thinners, which are always necessary with mechanical valves. Valve repair also offers better durability than biological valves made out of animal tissue, which tend to deteriorate more quickly, especially in younger patients. Cardiac centres with exceptional surgical experience and higher patient volumes indicate a better-than-average success rate with mitral valve repair.