AW: [HSF] Minimally invasive mitral valve repair

[Ani Anyanwu]

What does the echo show?
 
The most important thing to do here IMHO is to carefully study the echo and identify the etiology of the MR, the dysfunctions present and lesions present. It is these that will determine the success and durability of repair and the successfulness and durability will vary for different etiologies, lesions and dysfucntions depending on the surgical incision used.
 
For example, if her problem is a P2 prolapse from a ruptured chord, this could be repaired easily and successfully by any means - even maybe percutaneously - and would therefore be a good case for a robotic assisted repair. Whereas if you are dealing with Barlow's with multisegmental prolapse and calcification then the patient is best served by referral to a mitral surgeon with a high repair rate for such valves (most likely via sternotomy, but still possible via other means), as a 'mini-invasive' approach in most hands will likely result in a replacement. Similarly, if the dysfunction is IIIA rheumatic then sending her to a robotic surgeon may not be in her interest. Same applies for IIIB dysfunction as the ability to perform a complete ring remodelling restrictive annuloplasty is limited in most hands with the robotic approach.
 
I would look at the echo, identify what needs to be done to fix her valve and then advise on the best means of achieving this. As Hal I am sure would agree, you have to match the technique to the valve, and not match the patient to the technique; I am sure Hal studies the pre-op echo carefully before deciding on the robot or sternotomy - this I think is the key rather than simply what the patient wants. If she has robotic ammenable etiology and lesions then refer her on, if not advice her to have a conventional repair.
 
Ani



> From: Cysmd613 at aol.com> Date: Thu, 6 Sep 2007 01:05:52 -0400> Subject: Re: AW: [HSF] Minimally invasive mitral valve repair> To: OpenHeart-L at lists.hsforum.com> CC: > > A 58 yo nurse who I know with symptomatic MR needs a repair. She insists on > "minimally invasive"/robotic. She is willing to travel to have the procedure > done. Do you know who is doing a lot of these procedures with excellent > results?> Thank you,> > Carmi Stadlan> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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