Cardiothoracic surgeon at Johns Hopkins Suburban Hospital, Hanghang Wang, discusses when patients with mitral valve disease should be referred to a surgeon, and considerations when choosing between repair and replacement. She also explains the specialized cardiac care patients receive at Suburban Hospital. #MitralValveDisease #JohnsHopkins https://www.hopkinsmedicine.org/heart
The current guidelines state that patients should be referred when their LVN systolic dimensions are greater than four centimeters. However, we think that patients should be referred earlier, especially for women. We would like to see them much earlier before their LVESD reaches four centimeters because of their smaller size. They tend to have poorer outcomes when they reach this threshold. We are actively researching on better indications for surgery. This includes biomarkers and imaging parameters to refer patients earlier for surgery before they develop any signs and symptoms of ventricular dysfunction. Mitral valve repair offers a ton of benefits over mitral valve replacement. This includes the fact that the patients go back to their normal lives. It is a much more physiologic operation and patients have the same survival as someone their same age if they haven't had any cardiac surgery. This is not the case for a mitral valve replacement for younger patients. We often will replace their mitral valve with a mechanical valve. This means they have to be on lifelong anticoagulation for older patients. They are replaced with a biologic valve. This means they will need redo operation years down the line for mitral valve repair these patients go back to their normal lives as if they haven't had cardiac surgery. At Johns Hopkins, we are able to repair the mitral valve for degenerative mitral valve disease more than 95% of the time. This means when a patient presents with degenerative mitral valve disease, if they go to a different center, they may receive a mitral valve replacement when they could have received a mitral valve repair. At Johns Hopkins. We approach mitral valve repair with a restoration technique. We attach artificial cores to the mitral valve leaflet without any resection. This preserves the geometry and is much more physiologic. We are able to restore the geometry of the mitral valve leaflet. More than 95% of the time a suburban hospital patients have the benefit of having Johns Hopkins expertise closer to home for a mitral valve disease. We have a multidisciplinary team that helps the patient decide the best treatment, the personalized treatment for them. When patients come to suburban on their day of surgery, they are greeted by an ambassador of the hospital giving them a feel of being in a small close knit community. This is coupled with the expertise of Johns Hopkins where we are able to repair the mitral valve. Most of the time, we also offer a state of the art cardiac rehab program which helps the patients go back to their normal lives. Patients receive the personalized care of a community hospital as well as the expertise of Johns Hopkins, the best of both worlds. As a center of excellence for mitral valve repair, we also want to help the greater cardiac surgery community with mitral valve repair techniques. We are working closely with cardiac anesthesiologists to develop artificial intelligence algorithms to analyze the mitral valve. This will help us determine the best surgical plan for these patients.
