Severe Mitral Valve Disease: 'Timely Surgery is Crucial for Survival'

Q&A with Cardiovascular Surgeon Dr. Daniel O’Hair
People with mild mitral valve regurgitation often live long, full lives and never require treatment. But once the condition becomes severe and begins to affect your heart’s ability to pump blood, you may need surgery to prevent serious complications such as congestive heart failure or even death.

We recently sat down with cardiovascular surgeon Dr. Daniel O’Hair to learn more about the dangers of severe mitral valve disease and the latest surgical treatments, including minimally invasive robotic-assisted mitral valve surgery.

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VIDEO: Watch "Latest Treatments for Mitral Valve Disease"
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BCH: What happens when you have mitral valve regurgitation?
O’HAIR: The mitral valve sits between the two chambers — the left atrium and left ventricle — on the left side of your heart. It has two flaps, or leaflets.

With mitral valve regurgitation, one or both leaflets don't close tightly and billow into the left atrium. This causes some blood to leak backward into the atrium each time the heart squeezes. The leaky valve makes the heart work much harder, and this can ultimately lead to heart failure.

BCH: What is the impact of this condition?
O’HAIR: Researchers have discovered that most individuals with a mild leak in the valve are still alive five years after diagnosis. However, for those with a severe leak that goes untreated, survival drops way off, hovering around 60% surviving at five years. So, it matters how bad your valve leaks. And, severity has a direct impact on your risk of death, even at five years.

BCH: What are the symptoms of mitral valve disease?
O’HAIR: Signs and symptoms of mitral valve disease may include:

• Abnormal heart sound (heart murmur) heard through a stethoscope
• Fatigue
• Shortness of breath, particularly when you have been very active or when you lie down
• Swelling of your ankles and feet
• Irregular heartbeat

However, sometimes mitral valve regurgitation does not cause any symptoms, even when the problem becomes severe.

BCH: Why is it important to treat severe disease – even when you don’t have symptoms?
O’HAIR: The heart has an ability to compensate for a long period of time. Which means your valve can leak a lot and you feel fine. So, when someone tells you that you need heart surgery, and you feel fine, that can be a roadblock to treatment.

However, if patients aren’t treated in a timely fashion, their mortality rate is significantly higher. When we treat patients with mild or no symptoms, when their heart is still strong, long-term survival returns to normal. In fact, if you look at people with a severe leak in their mitral valves, and you fast forward 10 years, 90% of those who choose not to have surgery will be dead. It’s that critical.

The quicker we can stop the severe leak – even when you experience no symptoms – the better the outcome.

BCH: How do you repair a damaged mitral valve?
O’HAIR: During surgery, we cut a segment of the mitral valve leaflet that’s billowing and then sew the leaflet back together, allowing the valve to close more tightly.

There are a few different ways we can perform this procedure. In the traditional operation, which is a sternotomy, we saw through the breastbone, down the midline, to get to the valve. A second way is called mini-mitral access, done with an incision on the side of the body, between the ribs.

However, my preferred approach is using a robotic-assisted approach with BCH’s da Vinci robotic surgical system.

BCH: How do you perform robotic-assisted repair?
O’HAIR: With robotic-assisted surgery, I don’t have to cut any bones or muscles, which facilitates recovery. This is done from the right side of the chest, because access to the valve is best achieved from the right side.

Robotic-assisted surgery requires only a few small incisions for inserting surgical equipment and a camera for viewing. Because it requires only small incisions, patients’ hospital stays are short, roughly 2.5 days, and they can return to work within 10 days.

BCH: Can you tell us about BCH’s program for robotic-assisted mitral valve surgery?
O’HAIR: BCH’s Foothills Hospital is home to the da Vinci Xi surgical system, the most advanced minimally invasive option, offering greater precision for mitral valve repair. We started the mitral valve repair program at BCH in February 2019, and already we’re the largest program in the state. Patients have come to us from Colorado, Kansas, Wyoming, Florida and even Germany for this surgery.

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Click here to view/download a PDF of slides from "Latest Treatments for Mitral Valve Disease."
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To make an appointment with Dr. Daniel O’Hair, call Boulder Heart at 303-442-2395.