Robotic mitral valve repair and replacement is concrete proof of what today’s technology is capable of. Before we interfere the mitral valve with the robot, let’s get to know the mitral valve.
What is the mitral valve?
It is one of the four valves in our heart. It is located between the left atrium and the left ventricle. It acts as a gate through the left atrium to the left ventricle for the blood which cleans in the lungs and comes from to the pulmonary vein. At the same time, its another and perhaps most important task is to prevent the return of the blood to the left atrium and lungs before leaving the left ventricle. The anterior and posterior leaflets, the annulus (frame), the under-cover tissue, the papillary muscular system, and the dozens of suspending mechanism called the chorda tendinea serve, knowns as the apparatuses of the mitral valve, work in a miraculous function in perfect coordination.
What is mitral valve failure and stenosis?
As a result of various pathologies occurring in the apparatus of the mitral valve, narrowing of the valve (stenosis) occurs or regurgitation of blood towards the left atrium occurs, due to insufficiency. As a result of rheumatic fever in childhood age, thickening of the valve leaflets, calcification of the subcutaneous tissues, shortening and thickening of the chords and papillary muscles with a suspending mechanism result in stenosis of the valve. The blood flow from the left atrium to the ventricle becomes difficult and over time the blood starts to pool in the lungs. Mitral insufficiency is characterized by hereditary diseases, enlargement of the valve frame, withdrawal of the valve leaflets and elongation or rupture of chords as a result of infection or unknown diseases of connective tissue. And as a result of mitral insufficiency mitral valve leakage occurs.
What are the symptoms of mitral valve disease?
We can say that it is an insidious disease since symptoms like palpitation due to excessive enlargement of the left atrium, and shortness of breath caused by valve shortness and insufficiency gradually develop over the years. Due to the increase in shortness of breath in the later stages of valve stenosis, patients try to sleep in sitting position with several pillows. In the late period, increased shortness of breath may be accompanied by cough and haemoptysis. Red cheeks and purple lips are late period findings that we don’t see much anymore.
What is mitral valve replacement?
Due to excessive thickening, stenosis and irreparable degeneration of the valve tissue, the procedure of removing the mitral valve with a suitable technique and replacing it with a mechanical or biological valve is called replacement.
What is mitral valve repair?
As a result of the pathologies in the mitral valve, the repair of cases with valve insufficiency (leaking) or both leaking and stenosis is possible with the use of appropriate techniques in highly qualified hands (97%). Since the repaired valve is the patient’s own tissue, there is no need for the use of blood-thinners, which must be used in mechanical valves. In addition to the difficulties in the use of blood thinners, serious drug-related side effects adversely affect the long-term survival rate regardless of the operation.
Is mitral valve repair possible by robotic method?
While the rate of mitral valve repair in only mitral valve disease cases by conventional means, namely sternotomy, is 50% in cases in the United States and 20% in cases in Europe, it is still performed by very few cardiac surgeons in our country. While this is the case, the number of cardiac surgeons and centers performing mitral valve repair with the robotic method, which requires long international educations and experience, is only a few in our country.
Robotic mitral valve repair and replacement is concrete proof of what today’s technology is capable of. Before we interfere the mitral valve with the robot, let’s get to know the mitral valve.
What is the mitral valve?
It is one of the four valves in our heart. It is located between the left atrium and the left ventricle. It acts as a gate through the left atrium to the left ventricle for the blood which cleans in the lungs and comes from to the pulmonary vein. At the same time, its another and perhaps most important task is to prevent the return of the blood to the left atrium and lungs before leaving the left ventricle. The anterior and posterior leaflets, the annulus (frame), the under-cover tissue, the papillary muscular system, and the dozens of suspending mechanism called the chorda tendinea serve, knowns as the apparatuses of the mitral valve, work in a miraculous function in perfect coordination.
What is mitral valve failure and stenosis?
As a result of various pathologies occurring in the apparatus of the mitral valve, narrowing of the valve (stenosis) occurs or regurgitation of blood towards the left atrium occurs, due to insufficiency. As a result of rheumatic fever in childhood age, thickening of the valve leaflets, calcification of the subcutaneous tissues, shortening and thickening of the chords and papillary muscles with a suspending mechanism result in stenosis of the valve. The blood flow from the left atrium to the ventricle becomes difficult and over time the blood starts to pool in the lungs. Mitral insufficiency is characterized by hereditary diseases, enlargement of the valve frame, withdrawal of the valve leaflets and elongation or rupture of chords as a result of infection or unknown diseases of connective tissue. And as a result of mitral insufficiency mitral valve leakage occurs.
What are the symptoms of mitral valve disease?
We can say that it is an insidious disease since symptoms like palpitation due to excessive enlargement of the left atrium, and shortness of breath caused by valve shortness and insufficiency gradually develop over the years. Due to the increase in shortness of breath in the later stages of valve stenosis, patients try to sleep in sitting position with several pillows. In the late period, increased shortness of breath may be accompanied by cough and haemoptysis. Red cheeks and purple lips are late period findings that we don’t see much anymore.
What is mitral valve replacement?
Due to excessive thickening, stenosis and irreparable degeneration of the valve tissue, the procedure of removing the mitral valve with a suitable technique and replacing it with a mechanical or biological valve is called replacement.
What is mitral valve repair?
As a result of the pathologies in the mitral valve, the repair of cases with valve insufficiency (leaking) or both leaking and stenosis is possible with the use of appropriate techniques in highly qualified hands (97%). Since the repaired valve is the patient’s own tissue, there is no need for the use of blood-thinners, which must be used in mechanical valves. In addition to the difficulties in the use of blood thinners, serious drug-related side effects adversely affect the long-term survival rate regardless of the operation.
Is mitral valve repair possible by robotic method?
While the rate of mitral valve repair in only mitral valve disease cases by conventional means, namely sternotomy, is 50% in cases in the United States and 20% in cases in Europe, it is still performed by very few cardiac surgeons in our country. While this is the case, the number of cardiac surgeons and centers performing mitral valve repair with the robotic method, which requires long international educations and experience, is only a few in our country.
What are the benefits and advantages of robotic mitral valve repair or replacement?
As in all robotic open heart surgery cases, the patient feels much less postoperative pain because of the very small incision. Depending on the small incision, the amount of bleeding in the patient after surgery is small, so that the patient is not given unnecessary blood and blood products for external reinforcement. As the chest bone is not cut, the ability to wear the desired clothes freely by the patients, who do not have any scars and wounds in this region, provides a psychological positive contribution, and the healing process of the patient is accelerated. Compared with the classical method, the length of stay in the intensive care unit and the total length of hospital stay are almost half less.
In addition, in mitral repairs with robots, the error rate is almost negligible since the operation area is enlarged 20 times more. This makes a very positive contribution to long-term success after repair. Mitral valves which cannot be repaired, are easily replaced with the help of robots. Along with mechanical valves, biological valve replacement is performed to prevent the use of blood thinners in patients over 60 years of age.
In addition to tricuspid valve repair in the right atrium during the same surgical procedure, radiofrequency ablation can be performed for the treatment of rhythm problem called atrial fibrillation and suturing the end of the left atrium to prevent paralysis due to blood clots can be performed with the robot. The long-term success of mitral valve repair or replacement in robotic surgery is closely related to the experience and training of the surgical team and the hospital. The fact that the team has been trained abroad for a long time and performed a certain number of operations is one of the issues that should not be ignored in the selection of the hospital.