June 13, 2010
Tomislav Mihaljevic, MD
Tomislav Mihaljevic, MD, Cleveland Clinic Department of Thoracic and Cardiovascular Surgery
Minimally Invasive Heart Surgery
Minimally invasive heart surgery (also called keyhole surgery) is performed through small incisions, sometimes using specialized surgical instruments. The incision used for minimally invasive heart surgery is about 3 to 4 inches instead of the 6- to 8-inch incision required for traditional surgery.
Robotically-Assisted Heart Surgery
Robotically-assisted heart surgery, also called closed-chest heart surgery, is a type of minimally invasive surgery. The cardiac surgeon uses a specially-designed computer console to control surgical instruments on thin robotic arms. Robotically-assisted technology allows surgeons to perform certain types of complex heart surgeries with smaller incisions and precise motion control, offering patients improved outcomes. In robotic surgery, small incisions – less than 2 inches – are used, compared with the 3- to 4- inch incision used in traditional minimally invasive heart surgery.
Cleveland_Clinic_Host: Welcome to our online health chat with Tomislav Mihaljevic, MD. He will be answering a variety of question on "Robotically and Minimally Invasive Heart Surgery". We are very excited to have Dr. Mihaljevic here! Thank for joining us Dr. Mihaljevic, let's begin with the questions.
Speaker_-_Dr__Tomislav_Mihaljevic: Hello - we have lots of questions - let's begin.
Mitral Valve Surgery
GregT: Are you regularly using minimally invasive repair techniques for mitral valve prolapse and moderate (25%) mitral valve regurgitation in pediatric cases?
Speaker_-_Dr__Tomislav_Mihaljevic: I do not do pediatric surgery - but our team at Cleveland Clinic Children's Hospital are world renowned for surgical treatment of congenital heart disease.
jimL: My mother, age 84, has 2 mitral valve "clips" (experimental), but continues to have regurgitation. Would she be a candidate for the minimally invasive Mitral valve repair surgery? She has refused to consider the valve replacement surgery, but I think she might consider the repair. Please advise.
Speaker_-_Dr__Tomislav_Mihaljevic: Yes there is a potential option for minimally invasive approach for a failed clip of the mitral valve. The advantage of repair over replacement in elderly patients has not been documented - both operations could be done doing a minimally invasive approach although this would require a thorough review and a complete workup prior to surgery.
MaryannW: These are my questions: 1. Have there been newer-designed robotic devices developed since 2005, in regard to mitral valve replacement where less-invasive procedures are used? 2. Assuming that a patient undergoes routine heart function tests for monitoring purposes, proactively would you repair a mitral valve if a patient experiences preventricular contractions but does not experience atrial fibrillation yet?
Speaker_-_Dr__Tomislav_Mihaljevic: There have been improvements in the design of robotic instrumentation for mitral valve surgery. The instruments are becoming smaller and more sophisticated allowing better performance of the operation through smallest incision less than 1 cm in length. Indication for Mitral valve repair primarily depends on severity of mitral regurgitation. In patients with severe mitral regurgitation with or without atrial fib the surgery should be considered.
KathrynW: If I receive a valve repair and I have scoliosis in my back how will the surgery affect my back maintenance . My ribs routinely slip out of place and worry me because what could be heart issues are really my ribs. Also I am allergic to wheat are their any drugs that are used in surgery that might have wheat. Influenza shots have squalene which is derived from wheat germ making them toxic for me. In addition how likely is it that if you and a patient discuss getting a repair and complications arise that you have to replace with a valve that a patient is not in agreement on getting, that you have to do that regardless of what the patients wishes are?
Speaker_-_Dr__Tomislav_Mihaljevic: There are a high percentage of patients with scoliosis who have associated valve disease primarily mitral regurgitation. The best surgical approach has to be determined after a thorough work up and is primarily influenced by severity of scoliosis.
The mitral valve repair in our practice can be accomplished in more than 99% of the patients and this is the highest repair success rate ever reported. However, in rare cases during which mitral valve repair cannot be accomplished - the mitral valve replacement must be done and the choices for mitral valve replacement prosthesis are always discussed with the patient before surgery.
Ellen: I have mitral valve prolapse with moderate to severe regurgitation. I have thickening of the leaflets, calcification and one torn chord and am facing surgery soon. Is it possible to do a minimally invasive repair rather than replacement of the valve?
Speaker_-_Dr__Tomislav_Mihaljevic: Yes. Based on the information you have provided, we believe repairing the valve would be most likely be possible. However, we would need access to your complete medical documentation to provide you with an accurate assessment of your condition and propose the ideal optimal treatment for you.
ebvgeorge: I have mitral valve prolapse. My Cardiologist says, “After having a chance to look at and feel the valve” the Surgeon makes a decision whether the valve will be repaired or replaced. Is this the case? Which heart surgery technique provides the best opportunity to evaluate the valve?
Speaker_-_Dr__Tomislav_Mihaljevic: The best diagnostic tool for valve evaluation is an echocardiogram. Successful mitral valve repair can be accomplished in more than 95% of patients with leaking mitral valves and that rate is always higher in the centers with greater surgical expertise. The likelihood of repair can always be determined after review of echocardiogram before the surgery.
Eddie: What additional risks are involved in mitral valve surgery for elderly (85-year-old) patients in otherwise good health?
Speaker_-_Dr__Tomislav_Mihaljevic: There are no increased risks for patients with mitral valve disease from the cardiac standpoint related to their age. The increased risk of surgery is most of the time related to additional health concerns or illnesses that are more commonly found in elderly people.
heywood: How many minimally-invasive mitral valve repairs do you perform at the Cleveland Clinic each year?
Speaker_-_Dr__Tomislav_Mihaljevic: We have the worlds largest practice in minimally invasive and robotically assisted mitral valve surgery with close to 1000 mitral valve operations and close to 400 being done with the minimally invasive or robotically assisted approaches.
roullac: Dr Mihaljevic I would like to take this opportunity to thank you very much for successfully repairing (Median Sternotomy due to evidence of persistent vena cava with a large diameter of the coronary sinus) my mitral valve on the 24th of August 2009. The operative findings were: myxomatous mitral valve disease with prolapse of the P segment of the posterior leaflet and a partial calcification of the base of the posterior leaflet as well as the leaflet as well as the posterior aspect of the mitral annulus. Given the above findings would this repair be durable as any other repair? Would this represent a lifelong solution? Would my lifespan be the same as the rest of the population? Would I need another surgery to replace the valve? Once again thank you very much!
Speaker_-_Dr__Tomislav_Mihaljevic: The successful mitral valve repair in the vast majority of patients is a solution for life. There is approx a 5% lifelong risk of reoperation meaning that for about 95% of patients, mitral valve repair is their first and only valve operation. The successful mitral valve repair is one the very few operations that completely restores normal life expectancy.
kris: I have MVP. My cardiologist suggested I may be eligible for robotic surgery. I am aware of the advantageous of robotic surgery such as faster recovery and less hospital time. Could you please highlight the advantageous of traditional surgery (sternotomy) over robotic surgery if any when one is a good candidate for both. Thank you.
Speaker_-_Dr__Tomislav_Mihaljevic: Our most recent comparison of various surgical approaches for mitral valve operations, have shown that robotic mitral valve surgery is as safe and as effective as operations performed through complete or partial sternotomy. Robotic surgery results in a shorter hospital stay and faster return to work. All patients with leaky mitral valves are considered for mini invasive or robotic approach but the decision is made after a complete diagnostic workup. Most common reasons for not being able to do a robotic surgery include presence of blockages in leg vessels or atherosclerosis of the aorta.
sajasaj: Is robotic repair of mitral valve riskier than sternotomy for the elderly?
Speaker_-_Dr__Tomislav_Mihaljevic: No. Robotic mitral valve is not associated with greater risk in any patient population based on our experience.
Dharsch: I had robotically assisted mitral valve repair that is now leaking again, does replacing cords combined with mitral valve repair skew the 99% success rate.
Speaker_-_Dr__Tomislav_Mihaljevic: No - there is no difference in success rate of robotic repair with chordae vs. alternative techniques.
Mitral Valve Surgery and Atrial fibrillation
beary: Do the Doctors at The Cleveland Clinic do both mitral valve repair and maze procedure for atrial fibrillation using minimal invasive technique in the same operation
Speaker_-_Dr__Tomislav_Mihaljevic: Yes. We can use mini invasive approaches including robotically assisted heart surgery for procedures such as mitral valve, tricuspid valve and atrial fibrillation procedures - or a combination of all of them.
BobB: do your Doctors that repair Mitral Valve also do ablation for Atrial fibrillation at the same time?
Speaker_-_Dr__Tomislav_Mihaljevic: Yes - robotically assisted surgery is available for mitral valve repair combined with atrial fibrillation procedures and are commonly done at the Cleveland Clinic.
ebvgeorge: Thank you Dr. Mihaljevic for taking my questions. The terms Maze and Mini-Maze are used. CCF Dr Lindsey is quoted, “It is analogous to a limited catheter ablation procedure.” What type of procedure is used during open heart surgery for Mitral valve repair? Is the same procedure used during minimally invasive surgery? Would you describe one procedure as more effective than the other?
Speaker_-_Dr__Tomislav_Mihaljevic: Maze procedure is indicated for patients with long standing atrial fibrillation. More limited form of maze procedure is commonly called mini-maze or pulmonary vein isolation - is indicated for patients with intermittent (occasional) bouts of atrial fibrillation. Both procedures are done in a similar fashion regardless of the type of incision done for mitral valve surgery.
AnnZ: That is interesting because I have not been offered ablation for my Atrial Fib because of the leaking valve as I understand it.
Speaker_-_Dr__Tomislav_Mihaljevic: This is very common for us to treat atrial fibrillation and mitral valve leak during the same surgery.
jmgarlow: I have been in atrial fib for 8 years. I've had valve replacement twice, most recently in January. I have been ablated and cardioverted and am still in afib with my heart running at a high speed. Could my new valve be causing these issues already?
Speaker_-_Dr__Tomislav_Mihaljevic: Most likely not.
jmgarlow: Could mini invasive surgery correct my atrial fibrillation?
Speaker_-_Dr__Tomislav_Mihaljevic: Yes it can correct your atrial fibrillation.
Aortic Valve Surgery
cth4: Re surgery for aortic stenosis, I have heard that there is a procedure now being used where the replacement valve is inserted through an incision in the groin. Is this accurate? Is the Cleveland Clinic doing this kind of surgery? Are you aware of any hospitals in Southern California that have experience with this? Thanks for your help. I'm going to need surgery to correct aortic stenosis in a year or two, and I want to avoid the open heart approach if at all possible.
Speaker_-_Dr__Tomislav_Mihaljevic: The percutaneous aortic valve replacement is being done at the Cleveland Clinic however this technology is being applied as a part of a clinical trial for very sick patients who are not good surgical candidates. Minimally invasive aortic valve surgery is our preferred approach for aortic valve replacement and it can be done through a 6 - 8 cm long incision with a very low risk (mortality of less than 1%) and a hospital stay of 4 - 5 days.
RichardS: I am a healthy, extremely active 76 year old for whom aortic valve replacement surgery has been recommended within the next 6 months due to moderate to severe AS. My cardiologist has been following me since 2003. The stenosis is getting very close to the critical stage. I have also been diagnosed with coronary artery disease and high cholesterol. I received two stents in minor arteries (I don't remember which ones) in 2003. I am experiencing no symptoms of the valve disease and in fact do about 2 hours of vigorous athletic activity 3 times a week and have been doing so my entire adult life. How is it determined if I am a candidate for minimally invasive aortic valve replacement?
Speaker_-_Dr__Tomislav_Mihaljevic: Provided you have not developed new blockages of your heart vessels since your last catheterization, You would most likely be a candidate for mini invasive aortic valve replacement - This would primarily be based on the findings of a repeat coronary angiogram.
Sue150: My husband, a 78 year old retired lawyer, has mild to mod. mitral and aortic insufficiency with aortic stenosis. His cardiologist says that he will be ready for valve replacement in about two years when his condition has deteriorated to congestive heart failure. The cardiologist says that the surgical risk is too great to do the surgery before that stage. I am wondering if this information is outdated. I would think he is going to have a better chance of success with minimally invasive surgery now while he is in better physical condition. Please let me know what you think.
Speaker_-_Dr__Tomislav_Mihaljevic: Generally speaking I agree with your comment. Most valve repairs and replacements can be done with a very low risk and it is wiser to do them before the patients condition deteriorates. This is also being reflected in ACC and AHA (American Heart Assoc) guidelines for treatment of valve disease which advocate surgery before onset of severe symptoms for most patients.
lugan1: I will be having surgery with you in a few weeks and was wondering what type of surgery will you be performing, I have aortic root dilation associated with bicuspid aortic valve, the peak instantaneous transaortic gradient is 82mm and a mean of 55mmhg with an estimated AVA .9cm2, moderate calcification. Mild to moderate aortic regurgitation with severe aortic value stenosis. The ascending aorta is mildly dilated, there is also severe concentric left ventricular hypertrophy, left ventricle is mildly dilated , left ventricular diastolic function is abnormal EF 60-65% the left ventricle has normal systolic function. With the type of surgery you perform what would you estimate the recovery period to be.
Speaker_-_Dr__Tomislav_Mihaljevic: Based on this information you will most likely require minimally invasive aortic valve replacement. The detailed information about your surgery will be provided during our preoperative meeting. Estimated length of stay after mini invasive aortic valve surgery is 4 to 5 days.
Coronary Artery Bypass Surgery
suzanne: Is coronary artery bypass surgery or a re-do considered minimally invasive surgery to be used robotically?
Speaker_-_Dr__Tomislav_Mihaljevic: Robotic bypass surgery can be done for patients with a limited extent of blockage in their heart vessels. For information about your particular case would require a review of your cardiac catheterization and medical documentation. For those now joining us, we are chatting with Tomislav Mihaljevic, MD who is answering questions on Robotically and Minimally Invasive Heart Surgery. To view what already has been discussed, please click on the "Transcript" button above the chat window. To submit a question, please type in the box below and then click on "Ask a question"
DebbieL: Who would be a good candidate for the less invasive bypass surgery? My dad needs a bypass surgery but has other health issues and is over the age of 70. My concern is the open heart surgery that is being recommended by his doctors may be too much for him to survive. Please advise. Thank you.
Speaker_-_Dr__Tomislav_Mihaljevic: Patients with more limited blockages in his heart vessels can be considered for a mini invasive bypass surgery. We mostly consider this for patients with blockages of the left coronary artery and its branches. Specific recommendations about the best surgical options for your father can be made only after a review of his records and test results.
armando: I have coronary artery blockage at 50% on 2 areas. Because prednisone use for many years, doctors consider by pass surgery as high risk due to bone healing. Is this correct?
Speaker_-_Dr__Tomislav_Mihaljevic: That is correct. Any surgery in patients who are on prednisone therapy is associated with a greater risk of delayed wound healing and a greater risk of wound infection.
mtool: would this robotic surgery be used on an LAD artery with 2 stents
Speaker_-_Dr__Tomislav_Mihaljevic: Yes - this is possible and the failed stenting of the LAD is one of the most common indications for robotic bypass surgery.
Adult Congenital Heart Surgery
Keiren: Hi Dr. Mihaljevic, I was hoping for your views on addressing Ebstein’s Anomaly in the context of “Robotically and Minimally Invasive Surgery”. This would be very helpful for a family member of mine who has Ebstein’s Anomaly and may in due course require a procedure (valve repair/replacement). I have 3 questions: (1) Are the Robotically and Minimally Invasive Surgery techniques you employ used by you/Cleveland for patients with Ebstein’s Anomaly? If so, how many cases has Cleveland Clinic operated on?
Speaker_-_Dr__Tomislav_Mihaljevic: Yes we have done minimally invasive approaches for Ebstein's however the best approach for Ebstein's Anomaly depends on the severity of Ebstein's disease which can vary substantially from patient to patient. I do not know how many have been done. We have one of the largest practices for treatment of congenital heart disease in adults however I do not know the exact number of this type of operation.
heywood: Can you repair a PFO during the robotic mini-invasive mitral valve repair?
Speaker_-_Dr__Tomislav_Mihaljevic: The answer is yes. Approximately 20 % of patients needing mitral valve repair also has a patent PFO which is easily closed during the operation.
Tumors and Minimally Invasive and Robotically Assisted Heart Surgery
maanag: Can a 1/2" tumor on the tricuspid valve be removed by mini-invasive or robotic assisted surgery?
Speaker_-_Dr__Tomislav_Mihaljevic: Yes. We have removed a large number of tumors using minimally invasive or robotically assisted heart surgery using a small incision on the right side of the chest. Typically these operations are associated with a very low operative risk and a hospital stay of 3 to 4 days.
Minimally Invasive and Robotically Assisted Heart Surgery
Keiren: (2) Related to (1), are the Robotically and Minimally Invasive Surgery techniques at Cleveland Clinic of similar/superior (?) precision to what is currently employed at other leading clinics? And is Cleveland developing more miniaturized surgical tools as seem to be under development at Boston Children’s Hospital as part of a 2007 grant? (www.childrenshospital.org/newsroom/Site1339/mainpageS1339P1sublevel340.html)
Speaker_-_Dr__Tomislav_Mihaljevic: Our presented and about to be published results on robotic heart surgery are the largest series in the world with the results that compare to previously published data. We have an active research laboratory for further development of robotically assisted and minimally invasive surgical tools. If you are interested in mitral valve repair, our repair rate for robotically assisted minimally invasive robotically assisted approaches exceeds 99% with 0.1% mortality.
Dharsch: When doing robotically assisted heart surgery, do you have good access to the rest of the heart? Are you able to see if any changes are happening in other places of the heart rather than just a focused view of the valve that you are working on?
Speaker_-_Dr__Tomislav_Mihaljevic: During robotic mitral valve surgery, we have excellent visualization of the heart - in particular the mitral valve. The evaluation of the remaining valves in the heart is always done through the review of echocardiographic images rather than direct inspection of the valves in the operating room.
normzee: What's the success rate for mini-invasive & robotic surgery? How does it compare to open heart surgery success rate?
Speaker_-_Dr__Tomislav_Mihaljevic: The robotic and mini invasive approaches are equally safe and effective as operations on the mitral valve with complete sternotomy. In our practice the risk of mitral valve surgery is minimal (risk of death of less than 0.1% and risk of stroke and MI of less than 1%). The mitral valve repair rate exceeds 99%. Minimal invasive approaches result in shorter hospital stay and faster return to work and daily activities of life.
Eddie: Are short plane flights risky for patients awaiting mitral valve repair? Are there any particular precautions that can taken to reduce complications from plane travel?
Speaker_-_Dr__Tomislav_Mihaljevic: We are not aware of any risk associated with plane travel.
roullac: Since I had my Median Sternotomy, (11 months ago) I have developed a small keloid scar what could you recommend for this? Can you please advise me if there is anything that I could possibly do (or use) to make the sternotomy incision less noticeable? Is there a possibility that given time the scar will hardly be noticeable? Thank you.
Speaker_-_Dr__Tomislav_Mihaljevic: I do not know of any effective treatment for keloid - you can seek the advice of a plastic surgeon or dermatologist.
Sue150: What are the risks and their frequency with valve repair?
Speaker_-_Dr__Tomislav_Mihaljevic: We commented on this already - the risks of valve repair are very low - the risk of death is less than 0.1 percent the risk of stroke or heart attack are less than 1 percent
Eddie: How is the urgency of mitral valve repair surgery evaluated? What are the risks associated with waiting weeks or months to meet a Surgeon's schedule. Patient is 85-year-old in otherwise good health, but long-term asymptomatic MVP has apparently been recently exacerbated by airbag-deploying car accident. New symptoms are shortness of breath when climbing multiple flights of stairs, and lung pressure of 69. Sorry about late question - I submitted last night, but this doesn't seem to have worked.
Speaker_-_Dr__Tomislav_Mihaljevic: In asymptomatic patients the risks of waiting for surgery are minimal. However, the surgery should be performed in patients who experience severe symptoms.
WhyMe_: My cardiologist seems to be steering me toward full sternotomy vs. minimally invasive, because he says there is greater visibility, but I only need the aortic valve replaced, no other surgery on the heart. I think it may be because his hospital doesn't do many min invasive techniques, or because min invasive is more expensive and the insurance company penalizes him if I go that route. Could my suspicions have any grounds?
Speaker_-_Dr__Tomislav_Mihaljevic: the minimally invasive surgery requires a trained surgeon with expertise in this particular field. The cost of surgery for insurance companies is identical for any operative incision technique for mitral valve surgery. You can contact your insurance company for insurance coverage at Cleveland Clinic.
Eddie: Thank you. Is lung pressure of 69 a sever symptom?
Speaker_-_Dr__Tomislav_Mihaljevic: Lung pressure of 69 is indicative of severe valvular disease which may or may not be associated with symptoms.
Minimally invasive and Robotically Assisted Heart Surgery: Consultation and Preparation
roger: I exercise vigorously, bike riding and weight lifting. Should I curtail it leading up to my late-September robotic mitral valve repair>
Speaker_-_Dr__Tomislav_Mihaljevic: You can continue to exercise with moderate intensity providing you are free of symptoms.
heywood: I am scheduled for minimally-invasive mitral valve repair with you in August :-). Is there anything I can do to prepare, to help make the surgery successful?
Speaker_-_Dr__Tomislav_Mihaljevic: Enjoy the summer. There is no special preparation for the surgery except for the continuation of a healthy lifestyle. I look forward to seeing you in August.
RHAZ77: Is it possible to do an initial consultation by telephone for mitral valve repair where you are sent a CD of a recent echocardiogram study, the written report of the TEE and the medical records?
Speaker_-_Dr__Tomislav_Mihaljevic: Yes - we have a process for review of medical records and contact you by phone. Please contact my office.
lweljwel: What are the best steps to take to arrange probable valve repair (two valves) for an Out of State patient?
Speaker_-_Dr__Tomislav_Mihaljevic: Simply contact our office - we have a process of sending medical records and films to our office for review. Many of our patients are out of state.
hafidb: how can I find out if I am a candidate for mid-cab or robotic heart surgery?
Speaker_-_Dr__Tomislav_Mihaljevic: Please contact our offices for a surgical review of your records.
Minimally invasive and Robotically Assisted Heart Surgery: Time on Heart-Lung Machine
WhyMe_: Does one spend much more time on the heart-lung machine for a minimally invasive aortic valve replacement that for a full sternotomy?
Speaker_-_Dr__Tomislav_Mihaljevic: Someone also asked this question related to mitral valve surgery. The minimally invasive and robotic operations are assoc with a somewhat longer operative time but the differences are negligible and they do not translate into increased risk or longer recovery. For mitral valve surgery - The average length of time during which the heart needs to be arrested is 60 - 70 minutes regardless of what type of approach used. For the aortic valve replacement there is no difference in coronary artery bypass times no matter what approach used.
Minimally invasive and Robotically Assisted Heart Surgery: Re-operation
Dharsch: so what is your advice for the 1% of us whose surgery was not a success?
Speaker_-_Dr__Tomislav_Mihaljevic: There is no cardiac operation associated with a 100% success rate - if there is a failed mitral valve repair the patient may need to be re-operated on depending on the degree of regurgitation.
normzee: I had quadruple bypass surgery in May 2010 and began to experience angina for the first time in my life about 5 weeks post op. My cardiologist explained to me after a recent angiogram that two of the grafts failed. Could I be a candidate for mini invasive surgery to repair what has failed?
Speaker_-_Dr__Tomislav_Mihaljevic: It is possible but very unlikely.
mayflower1000: Dr Mihaljevic, My mother (66 old) had a stroke 1.5 years ago due to Atrial Fibrillation (AF). She also has high blood pressure. She is hospitalized in China recently and was told, she now has: 1) Recurring Atrial Fibrillation (AF) 2) Enlarged Left Atrium (54mm), Right Atrium (horizontally measures 42mm & vertically measures 56mm) and Right Ventricle (23mm). Her Left Ventricle measures: 35 mm. 3) Regurgitation in Pulmonary Valve (3.40 CM2), Aortic Valve (4.35 CM2) and Tricuspid Valve (9.60 CM2) 4) Ejection Fraction reduced. Questions: a) Is my mother's heart dangerously enlarged/life threatening? b) is her heart valve regurgitation severe? Does she need heart valve repair or replacement? c) Given her enlarged (left) Atrium, how effective Radio frequency Catheter ablation would be for her AF? d) Any better options you could recommend? e) Is she safe to travel to the US for treatment (18 hours flight)? Thank you!
Speaker_-_Dr__Tomislav_Mihaljevic: Your mother's condition seems very advanced with multiple valves requiring replacement or repair. We would be happy to help her through our Global Patient Services to review her records and provide her with an evaluation - 216-444-8184.
rain39: Do you ever repair 3 valves at the same time? I seem to have 3 bad ones... no symptoms.
Speaker_-_Dr__Tomislav_Mihaljevic: Yes. We routinely perform valve surgery on three valves in the same setting. Occasionally this operation can be done with a mini invasive approach.
Keiren: How many minimally-invasive tricuspid valve repairs/replacements do you perform at the Cleveland Clinic each year?
Speaker_-_Dr__Tomislav_Mihaljevic: I do not know that exact number but I would estimate that we do 200- 300 tricuspid valve repairs here yearly.
genodoc: Knowing that there is a percutaneous repair possible with the Mitraclip for mitral valve repairs, do you foresee a similar product for aortic valve repairs(Aortic Insufficiency secondary to a floppy leaflet), thus eliminating the need for sternotomy (partial), aorto-pulmonary bypass?
Speaker_-_Dr__Tomislav_Mihaljevic: No. we do not for see creation of similar devices for aortic regurgitation because the anatomy of the aortic valve is markedly different than the anatomy for the mitral valve. The clip procedures for mitral regurgitation will most likely be available only for patients who are high risk and not good surgical candidates.
Cleveland_Clinic_Host: I am sorry to say our time with Dr. Mihaljevic is now over, he was not able get to all the questions, but the ones that were answered will be available in transcripts. After the close of the chat if you have additional questions please submit through www.clevelandclinic.org/contact.
Speaker_-_Dr__Tomislav_Mihaljevic: Thank you for having me today.
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