Comprehensive Heart Valve Repair Program - Surgical Procedures - Heart Valve Repair and Valve Sparing Surgery - New York - Montefiore Medical Center

Montefiore's valve specialists recognize the benefit of preserving the patient's own heart valve and are dedicated to pursuing valve repair as a primary treatment option. In most cases, patients are treated using a minimally invasive surgical approach that may include endoscopy or robotic-assisted valve surgery. Patients who require open-heart surgery are treated with the most advanced approaches available for their conditions. Depending upon the circumstances, Heart Valve Repair Program surgeons will use incisions made between the ribs or breastbone that are up to two-thirds smaller than traditional surgical incisions.

	Butterfly Repair of the Mitral Valve

Benefits associated with valve repair or valve-sparing surgery include:

• Preservation of heart function
• Reduced risk of stroke and infection (endocarditis)
• No need for blood thinners
• Improved quality of life

Treatment Options

Montefiore's surgeons offer many surgical repair options for individuals with complex valve disease. Montefiore is a regional and national leader in mitral valve repair, with among the lowest risk-adjusted operative mortality rates for this procedure. Heart Valve Repair Program surgeons are also experienced in repairing aortic and tricuspid valves as well as aortic aneurysm, and in performing valve-sparing aortic replacement. Our surgeons strive to use minimally invasive techniques at all times, thereby reducing the postoperative discomfort and length of recovery.

We offer the following surgical repair options for patients with valve disease:

Mitral Valve Repair

Mitral valve repair is the preferred treatment for patients with mitral valve regurgitation. Nearly all mitral valve repairs can be performed minimally invasively through a two- or three-inch incision on the right side of the chest. Surgeons at Montefiore are skilled in the treatment of patients presenting with mitral valve disease and atrial fibrillation. For these patients, surgeons perform ablation (Maze procedure) at the time of valve repair to cure the atrial fibrillation.

The "Einstein" Repair

The "Einstein" repair uses artificial chord implantation for mitral valve repair. Created by Robert Frater, MD, an Einstein professor, the "Einstein" repair has been used by surgeons around the world to the benefit of thousands of patients.

Aortic Valve Repair

Aortic valve disease encompasses valve stenosis and valve regurgitation and can be the result of a congenital birth defect or acquired over time. While most patients with aortic valve disease undergo valve replacement surgery, select individuals may be candidates for repair. Aortic valve repair techniques include aortic valve repair for leaking valves and the repair of an enlarged aorta. A valve-sparing aortic root replacement allows surgeons to repair the aortic valve and simultaneously replace the enlarged ascending aorta. Additionally, surgeons may patch valve leaflets if they have tears or holes.

Valve-Sparing Aortic Root Replacement

Montefiore surgeons specialize in treating patients with Marfan syndrome who suffer from thoracic aortic aneurysms. Valve-sparing aortic root replacement surgery preserves the patient's own aortic valve and avoids the need for anticoagulants. It may also reduce the patient's risk of stroke or endocarditis. During this procedure surgeons remove the aortic tissue and the aortic valve, and extending up into the ascending aorta. The aortic valve is then resuspended within a synthetic graft. The coronary arteries are also reattached to the synthetic graft.

Aortic Aneurysm Repair

This procedure is recommended when the diameter of the aorta exceeds a specific diameter. This definition varies according to specific patient-related factors. Montefiore has expertise in this evaluation. During an aortic aneurysm repair the dilated portion of the aorta is removed and replaced with a synthetic graft. Occasionally, aneurysm repair is combined with valve or coronary artery surgery if the aneurysm is located in the ascending aorta or aortic root.

Tricuspid Valve Repair

Tricuspid valve repair is commonly performed in concert with mitral valve repairs at Montefiore. In select cases, however, a tricuspid valve repair will be performed alone when the leaflets are floppy or prolapsed. Montefiore valve surgeons will typically use commissurotomy or annuloplasty to treat these conditions.

Pulmonary Valve Repair

At Montefiore, pulmonary valve repair is typically reserved for pediatric patients or those who have an infection. During this procedure, surgeons will repair or replace the diseased or damaged pulmonary valve with an artificial valve. The procedure can be done using minimally invasive techniques. Other pulmonary valve repairs include separating fused valve cusps, sewing torn cusps or reshaping parts of the valve so that it will close tightly.

Treatment Techniques for Repairing Heart Valves

The treatment of complex valve disease requires a tailored approach that takes into account the patient's physical condition, age, type of valve disease, and other medical problems. Aided by Montefiore's advanced cardiac imaging capabilities, Heart Valve Repair Program surgeons and cardiologists collaborate to develop a treatment plan that is personalized to the patient. Heart Valve Repair Program physicians are experienced in several different techniques to repair diseased heart valves, including:

• Valvuloplasty, a procedure that opens the leaflets of the heart; it is not a long-term option. Valvuloplasty is often performed by interventional cardiologists in a cardiac catheterization laboratory.
• Commissurotomy, a type of valvuloplasty that is used when leaflets of the valve become stiff and fuse together at the base, or ring portion (annulus), of the valve. During commissurotomy a surgeon either stretches or cuts into the valve leaflets.
• Annuloplasty, which repairs the valve by suturing fibrous tissue at the base of a heart valve or annulus with sutures or an implanted ring, thereby preventing blood from backing up into the left atrium.
• The "Einstein" repair, involves artificial chord implantation to correct anterior or posterior leaflet prolapse using artificial Gore-Tex chords or normal chordae and leaflet tissue from a normal leaflet to repair and support the valve. Insertion of an annuloplasty ring is routinely performed as part of this procedure.
• Valve-sparing aortic root replacement, used for patients who suffer from thoracic aortic aneurysms. Root replacement surgery allows surgeons to repair the aneurysm while preserving the patient's native valve.
• The Heart Valve Repair Program is currently participating in a national clinical trial evaluating the efficacy of the valve-sparing root replacement procedure in Marfan patients. Montefiore specializes in treating patients with Marfan syndrome who suffer from thoracic aortic aneurysms. Aortic root replacement surgery, which preserves the patient's own aortic valve, is the preferred form of treatment for Marfan patients. This surgery helps to avoid the need for anticoagulants and may reduce the risk of stroke or endocarditis.