Replay of: Minimally Invasive Mitral Valve Repair Webcast at the University
of Maryland Medical Center
First Seen: February 4, 2004
5:30pm EST (22:30 UTC)
BALTIMORE, MD — People who logged on to the Internet
on February 4, 2004, at 5:30 p.m., saw cardiac surgeons at the University
of Maryland Medical Center perform an innovative, minimally invasive mitral
valve repair. During the Webcast, surgeons used tiny instruments
and a video camera, placed through a two-inch “keyhole”
incision, to perform the same repairs that have traditionally required
“It’s the perfect operation to be done through
a small incision,” says James S. Gammie, M.D., a cardiac surgeon
at the University of Maryland Medical Center and assistant professor
of surgery at the University of Maryland School of Medicine, who will
perform the surgery during the Webcast. “This procedure reduces
the amount of blood loss, eliminates the need for a breastbone incision,
minimizes the chance of infection and allows patients to resume normal
Surgeons at the University of Maryland Medical Center
performed the first videoscopic mitral valve repair in the Mid-Atlantic
region in May 2003. The center is a leader in the surgical and medical
treatment of mitral valve disease.
Bartley P. Griffith, M.D., Chief of Cardiac Surgery at
the University of Maryland Medical Center and professor of surgery and
head of the Division of Cardiac Surgery and Cardiac Transplant at the
University of Maryland School of Medicine, will describe the procedure
and answer e-mail questions from viewers during the Webcast. “The
videoscopic approach meshes well with our emphasis on mitral valve repair
rather than replacement,” says Dr. Griffith. “We prefer
to fix a broken mitral valve rather than replace it, because a repair
lasts longer and rarely requires another operation down the road.”
The Webcast, the first in a series of four, originated from the University
of Maryland Medical Center’s new surgical facility, called the
O.R. of the Future. The 19-room O.R., which opened in June, combines
the most advanced video and other communications equipment with information
technology to enhance patient safety and operational efficiency.
“In traditional mitral valve repair, the actual view of the surgery
is hard to see for anyone but the surgeon,” says Dr. Gammie. “But
with the videoscope, we have a beautiful view on our flat panel monitors
in our new operating rooms, so everyone involved in the operation can
see what’s going on.” The Webcast adds a new dimension to
that view, according to Dr. Gammie, extending it throughout the region,
across continents and around the globe.
The mitral valve, shaped like a liturgical headdress worn by bishops
and abbots called a miter, is the “inflow valve” for the
left ventricle, the heart’s main pumping chamber. Blood flows
from the lungs, where it picks up oxygen, across the open mitral valve
and into the left ventricle. When the heart squeezes, the two leaflets
of the mitral valve snap shut and prevent blood from backing up to the
lungs. Blood is directed out of the heart to the rest of the body through
another valve, the aortic valve.
According to Dr. Gammie, there are two major problems that can occur
with the mitral valve. “It can be too tight, so it doesn’t
allow blood into the main pumping chamber,” says Dr. Gammie. “Or,
the valve can be leaky, so when the heart is squeezing, instead of sending
blood where it’s supposed to go, it backs up and goes in the wrong
Dr. Gammie says that about 90 percent of patients who come to the University
of Maryland Medical Center for mitral valve treatment have leaky valves,
and their most common symptom is shortness of breath. The goal during
surgery, says Dr. Gammie, is to “expose the valve, get a good
look at it, determine the exact problem, and perform the repair to create
a valve that is water-tight and works perfectly.”
Mitral valve surgery was first performed in 1960, when surgeons replaced
the diseased, native valve with an artificial valve. For the next 20
years, valve replacement was the gold standard, using either a metal,
mechanical valve or a valve made from cow tissue.
Dr. Gammie says neither device is as good as a patient’s own valve.
The metal valve tends to form blood clots, so patients must take a blood
thinning medication for the rest of their lives, with the risk of bleeding.
The tissue valves are less likely to cause clots, but they last only
10 to 15 years. “Both of those are okay options,” says Dr.
Gammie, “and certainly better than not fixing a diseased valve.
But we really like the idea of fixing a person’s own mitral valve.
We have a very high success rate of doing that.” Nationwide data
suggests that about six percent of patients with a valve replacement
do not survive the surgery. But Dr. Gammie says with a mitral valve
repair, the chance of survival is about 98 percent.
Several factors influence those numbers. The risk of stroke during and
after valve repair is extremely low compared to valve replacement. Artificial
valves can cause infection, but infection is unlikely when the patient’s
own valve is repaired. Further, repairs are much more likely to last
for the rest of the patient’s life.
Despite the benefits of repair over replacement, only about 40 to 45
percent of mitral valves nationwide are repaired. In centers that specialize
in mitral valve repair, such as the University of Maryland Medical Center,
that rate has climbed to about 90 percent. “Not every valve can
be fixed,” says Dr. Gammie. “There are some that are too
damaged and beyond repair. But we feel that a team approach focused
on fixing the valve truly helps patients. And the ability to do the
repair with a minimally-invasive approach takes the patient benefits
to an even higher level.”
Following the webcast, if you had additional questions about minimally
invasive mitral valve repair, you were able to post them in The Surgery
Forum at http://www.medhelp.org/forums/surgery/wwwboard.html.
This special forum will accept postings through February 12th. Dr. Gammie
and his surgical team from the University of Maryland Medical Center
will provide answers to your questions.
The University of Maryland School of Medicine is accredited by the Accreditation Council for Continuing Medical Education. (ACCME) to provide continuing medical education for physicians.
The webcast uses Realplayer
to display both video and synchronized slides in side by side windows.
Viewers can download
a free copy of the player here.
It is not necessary to purchase any of Real's premium players or subscription
plans. The free basic player is all that is required to view the surgery.