Da Vinci® Cardiothoracic Surgery

When medication and catheter-based treatments cannot relieve symptoms, surgery remains the accepted treatment for a range of cardiothoracic conditions, including but not limited to mitral valve prolapse, atrial septal defect and coronary artery disease.

Facing either traditional cardiac surgery or open surgery to treat disorders of the organs and tissues in the chest cavity can be a frightening experience. While it may be difficult to focus on next steps, in fact, you may have several choices to make, including which hospital and which surgeon to go to, and which procedure to choose. Learning as much as possible about your surgical options, including minimally invasive alternatives to traditional open surgery may ease some of your concerns.

While surgery is generally the most effective way to treat disorders of the heart, lungs and esophagus, traditional open surgery has a number of inherent drawbacks caused primarily by making a large incision, splitting of the breastbone and spreading the ribs to access the thoracic space. In addition to an 8 to 10” scar down the center of your chest, splitting of the breastbone leads to a lengthy recovery time of eight to twelve weeks as well as a prolonged delay before you will return to normal daily activities.

Fortunately, less invasive options are increasingly available for patients facing cardiothoracic surgery. Many cardiothoracic surgeons are recognizing the benefits of smaller incisions made between the ribs to perform coronary bypass or make repairs to the heart or esophagus under visualization using thoracoscopy – the insertion of a miniaturized video camera between the ribs. But this approach has limitations and is not well suited to more complex cardiac procedures.

Enter the da Vinci® Surgical System, providing surgeons and patients with what may be the most effective, least invasive treatment alternative for even the most complex cardiothoracic procedures such as mitral valve repair. Among the benefits of da Vinci® cardiothoracic surgery are a reduced risk of infection, less blood loss and need for blood transfusions, shorter hospital stay, less pain and scarring, faster recovery and a quicker return to normal activities. Additionally, surgery with the da Vinci Surgical System offers the potential for a better clinical outcome.

Mitral Valve Prolapse & Treatment
The mitral valve controls blood flow through the left side of the heart. When it opens, the mitral valve allows blood to flow into the left ventricle -- the heart’s main pumping chamber. When the left ventricle contracts, the mitral valve closes in order to prevent blood from flowing back toward the lungs. 

Sometimes the mitral valve is abnormal from birth. It can also become damaged by infection, with age or from heart disease.

What is Mitral Valve Prolapse?
If the mitral valve leaflets cannot tightly seal the left ventricle, this is called prolapse. With mitral valve prolapse, some blood flows back into the atrium – a condition called regurgitation. Regurgitation can make the heart work harder, leading to further valve damage and increasing the risk of heart failure.

Mitral Valve Prolapse Treatment Options
The treatment options available to a person with mitral valve prolapse depend on the severity of the condition. Some patients may not require any intervention. Others may be prescribed medications.

However, if your symptoms become severe, your doctor may recommend mitral valve prolapse surgery. There are two basic types of valve prolapse surgery: valve repair and valve replacement. In valve replacement, your surgeon cuts out the damaged valve and replaces it with a new, artificial valve. Valve repair involves the surgeon reconstructing your valve using your own tissues.
 

Mitral Valve Repair
The best available surgical treatment for mitral valve prolapse is repair. Mitral valve repair offers a number of significant, life-long benefits as compared to valve replacement. These include a lower risk of mortality, a better chance of long-term survival and more freedom from reoperation:

Approach
The most common way to repair a valve through surgery is with sternotomy – cutting through the breastbone and opening the ribs. Cutting through the body’s natural protective structure for the heart can cause significant trauma, prolong healing time and increase your risk for serious complications and even mortality. Moreover, an open approach doesn’t always provide the visualization and access necessary to complete a repair. In fact, the majority of patients who undergo sternotomy receive an artificial valve.

da Vinci  Mitral Valve Repair
If your doctor recommends surgery to treat mitral valve prolapse, you may be a candidate for da Vinci® Mitral Valve Repair, potentially the most effective least invasive treatment option available.

da Vinci Mitral Valve Repair is an alternative to conventional open heart surgery – the traditional way to treat mitral valve disease. da Vinci Mitral Valve Repair is performed using the da Vinci Surgical System, enabling your surgeon to operate with unparalleled precision and control through a few small incisions.

da Vinci can help your surgeon repair your valve and help you avoid mitral valve replacement, in which your natural valve tissues are cut away and replaced with an artificial valve. This is important because a repair can provide you with many significant advantages as compared with mitral valve replacement, including no need to take life-long blood thinners, less need for reoperation, reduced risk of surgical complications, a higher long-term survival rate and improved heart function. A recent study suggests that the da Vinci System may allow surgeons to complete 50% more repairs than they can when using an open surgical approach.

In addition to avoiding the pain and trauma of sternotomy and rib spreading, da Vinci Mitral Valve Repair provides most patients with the following benefits over open surgery:

• Less risk of infection
• Less blood loss and need for blood transfusions
• Shorter hospital stay
• Significantly less pain and scarring
• Faster recovery
• Quicker return to normal activities.
• And a potentially better clinical outcome 

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While da Vinci Mitral Valve Repair is considered safe and effective, it may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits. 

Please call 1-877-924-WELL (9355) to locate a da Vinci surgeon.

1. Rodgers, E. Heart valve repair or replacement for mitral valve regurgitation or prolapse. WebMD. March 10, 2005 Bach DS. Choice of prosthetic heart valves:update for the next generation. J Am Coll Cardiol. 2003 Nov 19;42(10):1717-9.
2. Ruel M, Kulik A, Rubens FD, Bedard P, Masters RG, Pipe AL, Mesana TG. Late incidence and determinants of reoperation in patients with prosthetic heart valves. Eur J Cardiothorac Surg. 2004 Mar;25(3):364-70. 
3. Thourani VH, Weintraub WS, Guyton RA, et al. Outcomes and Long-Term Survival for Patients Undergoing Mitral Valve Repair Versus Replacement. Circulation. 2003;108:298-304 (Emory University Atlanta)
4. Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL: Valve repair improves the outcome of surgery for mitral regurgitation: a long-term study. Circulation. 1995; 91:1022-8
5. Gillinov AM, Wierup PN, Blackstone EH, et al. Is Repair Preferable to Replacement for Ischemic Mitral Regurgitation? J Thorac Cardiovasc Surg 2001 Dec; 122(6):1125-41 (Cleveland Clinic)
6. Grossi E, Goldberg J, LaPietra A, et al. Ischemic mitral valve reconstruction and replacement: Comparison of long term survival and complications. J Thorac Cardiovasc Surg 2001 Dec; 122(6):1107-24 (NYU)
7. 96.2% received a repair with da Vinci Surgery, as reported by Douglas Murphy, MD, compared to 60% of patients in the Fall 2005 Sternotomy database, where 42,000 out of 70,000 received a replacement. See Society for Thoracic Surgeons & Duke Clinical Research Institute. Executive Summary. STS Fall 2005 Report. Murphy D, Smith M, Siwek L, Langford D, Robinson JR, Reynolds B, Seshadri-Kreaden U, Engel A. Multicenter Mitral Valve Study: a Lateral Approach using the da Vinci Surgical System. Pending publication. Data on file with Intuitive Surgical, Inc.