Mitral valve (MV) prolapse is one of the most frequent heart valve conditions encountered in the Western world. Estimates suggest that 2 to 4 percent of the general population are affected. Myxomatous mitral valve disease begins and progresses in young healthy individuals, becoming evident only later in life. MV prolapse is associated with stroke, atrial fibrillation, endocarditis and significant mitral regurgitation (MR). The importance of early diagnosis and effective treatment for this condition is central to restoring normal long-term life expectancy in affected individuals.
Determining the optimal timing of mitral valve repair
Our research has shown that delaying mitral valve repair until the development of symptoms, deterioration in heart function, or enlargement in heart size is harmful to patients. Our data suggest that mitral repair should be considered early in individuals with severe mitral valve regurgitation due to leaflet prolapse. Early repair optimizes the chance for long-term recovery of heart function and survival. We have also shown that survival following valve repair is superior to that seen following valve replacement surgery, with long-term durability that is equivalent to mechanical valve substitutes.
Robotic and minimally invasive valve repair
The use of high-definition imaging systems and robotic technology now allows complex valve repair surgery to be carried out via small incisions with the complete avoidance of a sternotomy. This approach has been shown to be associated with a decreased length of postoperative ventilatory support, shorter hospital stay, decreased postoperative functional limitation and a quicker return to normal activities. We are exploring new ways to perform traditional cardiac surgery through smaller and better tolerated incisions while ensuring that patients benefit from the same durable results offered by traditional "open" chest approaches. With the assistance of the DaVinci robotic platform or thoracoscopic instruments, we currently offer minimally invasive procedures to repair the mitral/tricuspid valves, close atrial septal defects, and treat atrial fibrillation. We are also working to develop new methods to perform robotic-assisted coronary bypass surgery and aortic valve replacement in our robotic laboratory.
Exploring the cause of myxomatous mitral valve disease
The underlying cause of myxomatous mitral valve disease is poorly understood, and we are often asked by patients, "Why do I have this condition, and are my family members at risk?". The notion that MV disease may be caused by an overactive immune system has not been studied to date, but inflammatory cells have recently been identified in myxomatous MV leaflets by us and others. We have identified protein abnormalities in myxomatous mitral leaflet tissue. These altered proteins may become targets of a normal immune system, causing the body to attack the otherwise normal mitral valve, which leads to weakening and failure of the mitral valve. Understanding this process further will allow us to devise new ways to prevent the onset and progression of myxomatous mitral valve disease.
Efforts to advance the scientific understanding, clinical diagnosis and surgical management of mitral valve disease are priorities in the Division of Cardiac Surgery at Mayo Clinic in Minnesota.