Importance of Heart Valve Repair
Monday, March 07, 2005
A new study suggesting that people with leaky heart valves with no symptoms are in greater danger than previously thought is highlighting the importance of valve repair surgery.
The study, published in the New England Journal of Medicine, showed that valve surgery gave normal life expectancy to patients with severe mitral regurgitation but no symptoms. Patients with severely leaky heart valves who were only treated with medication were more than five times more likely to die than those who underwent valve repair surgery, according to the Mayo Clinic study.
The mitral valve separates the left upper chamber of the heart (atrium) from the left lower chamber (ventricle).
Surgeons at Robert Wood Johnson University Hospital are increasingly performing mitral valve repair and replacement surgery using smaller incisions. What once required a 12-inch vertical incision is now being performed through a two- to three-inch incision. A smaller incision is less traumatic for the patient and lessens the chance of bleeding and infection.
Repair of the mitral valve, though technically more demanding for the surgeon, is preferable to replacement in appropriate patients because there are fewer complications. It also alleviates the need for blood thinning drugs, said Peter Scholz, MD, Chief of the hospital’s Cardiac Surgery Section and the James W. Mackenzie Professor of Surgery at UMDNJ-Robert Wood Johnson Medical School.
“Survival is better with repair than with replacement, heart function is better, there is less chance for infection and less chance of complications,” he said.
While Robert Wood Johnson University Hospital offers the spectrum of surgical options for valve disease and the latest generation of valve replacements, the hospital puts more emphasis on the preservation of the mitral valve, Dr. Scholz noted.
“While the newer generation of heart valves are more durable and have fewer complications, the results are not as good as if you preserve the existing valve,” he said.
The mitral valve is one of four valves that open and close to keep blood flowing in the proper direction through the heart. The mitral valve connects the heart’s upper-left chamber to the lower-left pumping chamber. When open, it allows oxygenated blood into the pumping chamber to be sent to the rest of the body. When closed, it keeps blood from flowing backward.
When the mitral valve doesn’t function properly, blood doesn’t move efficiently. One of the most common conditions is mitral valve regurgitation, also called mitral insufficiency, in which the valve doesn’t close tightly, allowing blood to leak backward. The condition can leave the patient fatigued and short of breath.
Mitral valve regurgitation has several causes. Some people are born with a leaky heart valve, while damage can occur through infections such as rheumatic fever and endocarditis. Age-related wear and tear on the valve can cause regurgitation, as can heart attack.
Mayo Clinic researchers used a new ultrasound technique to measure the hearts of 456 patients who had leaky valves and no symptoms. They found that the size of the regurgitant orifice in the valve was the strongest predictor of how the patient would fare. Without surgery, those with larger leakage did the worst.
About Robert Wood Johnson University Hospital
Selected as one of four hospitals nationwide to offer the world's first self-contained implantable artificial heart, Robert Wood Johnson University Hospital (www.rwjuh.edu) is a 600-bed academic medical center and the principal hospital of UMDNJ-Robert Wood Johnson Medical School in New Brunswick, NJ. Robert Wood Johnson is an innovative leader in advancing state-of-the-art care in medicine. Its Centers of Excellence include cardiovascular care from minimally invasive heart surgery to transplantation, cancer care, and women's and children's care including The Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital (www.bmsch.org). The hospital is also a Level 1 Trauma Center and serves as a national resource in its ground-breaking approaches to emergency preparedness.
The hospital has earned significant national recognition for clinical quality and patient safety. Robert Wood Johnson University Hospital is ranked among the top 50 hospitals in the nation for both heart and heart surgery and respiratory disorders, according to U.S.News & World Report's 2008 ranking of "America's Best Hospitals." The American College of Surgeons' Commission on Cancer has rated Robert Wood Johnson University Hospital among the nation's best comprehensive cancer centers. The Leapfrog Group rated Robert Wood Johnson University Hospital as one of the 50 exceptional U.S. hospitals, as published in Consumers Digest magazine. Harvard University researchers, in a study commissioned by The Commonwealth Fund, identified Robert Wood Johnson University Hospital as one of the top 10 hospitals in the nation for clinical quality. Robert Wood Johnson University Hospital is also a recipient of the prestigious Magnet Award for Nursing Excellence for more than 10 consecutive years.
Attention members of the media: For more information on this release, please contact the Department of Public Relations (732) 937-8521.
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