Robotic Mitral Valve Repair may provide patients with the following Benefits Over Open Surgery

In addition to avoiding the pain and trauma of sternotomy and rib spreading, robotic mitral valve repair may provide patients with the following benefits over open surgery:

• Less risk of infection
• Less blood loss and need for blood transfusions
• Shorter hospital stay
• Significantly less pain and scarring
• Faster recovery
• Quicker return to normal activities
• And a potentially better clinical outcome

Please note that not all patients are candidates for robotic surgery. Your surgeon will provide you with the most appropriate treatment option after thoroughly assessing your condition. 

WHAT IS THE MITRAL VALVE?

The mitral valve controls blood flow through the left side of the heart. When it opens, the mitral valve allows blood to flow into the left ventricle, the heart’s main pumping chamber. When the left ventricle contracts, the mitral valve closes in order to prevent blood from flowing back toward the lungs. 
Sometimes the mitral valve is abnormal from birth. It can also become damaged by infection, with age or from heart disease. 

WHAT IS MITRAL VALVE PROLAPSE?

If the mitral valve leaflets cannot tightly seal the left ventricle, this is called prolapse. With mitral valve prolapse, some blood flows back into the atrium – a condition called regurgitation. Regurgitation can make the heart work harder, leading to further valve damage and increasing the risk of heart failure. 

MITRAL VALVE PROLAPSE TREATMENT OPTIONS

The treatment options available to a person with mitral valve prolapse depend on the severity of your condition. Some patients may not require any intervention. Others may be prescribed medications. However, if your symptoms become severe, your doctor may recommend mitral valve prolapse surgery. There are two basic types of valve prolapse surgery:

Valve Replacement  - In valve replacement, your surgeon cuts out the damaged valve and replaces it with a new, artificial valve.

Valve Repair  - Valve repair involves the surgeon reconstructing your valve using your own tissues.

Robot Assisted Heart Procedures are done to treat a variety of conditions:

1. Robot Assisted Mitral Valve Repair may be used to treat:

• Stenosis (narrowing) of the mitral valve
• Regurgitation (leakage) of the mitral valve

2. Robot Assisted Coronary Artery Bypass Grafting (CABG) may be used to treat

• Blockages in the heart's arteries
• Severe chest pain ( angina ) that has not improved with medicines

3. Robot-assisted Atrial Septal defect repair may be used to treat a hole between the upper chambers of the heart that does not close properly during foetal development.

4. Robot-assisted Biventricular Pacemaker lead placement may be used to treat heart failure due to Atrial Fibrillation (irregular heart rhythm in the upper chambers of the heart)

An Alternative to Open-Heart Surgery

If your doctor recommends surgery to treat mitral valve prolapse, you may be a candidate for robotically assisted closed-chest heart surgery, potentially the most effective and least invasive treatment option. Robotically assisted minimally invasive mitral valve repair is an alternative to conventional open heart surgery. This mitral valve repair is performed using the da Vinci Surgical System®, enabling your surgeon to operate with precision through a few small incisions.

In addition to avoiding the pain and trauma of cracking open the breastbone to access the heart through a traditional sternotomy and rib spreading, robotically assisted minimally invasive mitral valve repair may provide patients with the following benefits over open-heart surgery:

• Less risk of infection
• Less blood loss and need for blood transfusions
• Shorter hospital stay
• Significantly less scarring
• Faster recovery from pain
• Quicker return to normal activities
• Potentially better clinical outcome

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While robotically assisted minimally invasive mitral valve repair is considered safe and effective, it may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

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What are modern artificial pacemakers and Type of Pacemakers

Artificial pacemakers are devices that are implanted into the body, just below the collarbone, to take over the job of the heart’s own electrical system and prevent slow heart rates. Although they weigh only an ounce and are the size of a large wristwatch face, a pacemaker contains a computer with memory and electrical circuits, a powerful battery (generator), and special wires called “leads.” The generator creates electrical impulses that are carried by the leads to the heart muscle, signaling it to pump.

Getting a pacemaker does not require open-heart surgery — the procedure usually takes only about two hours. The pacemaker generator is implanted in a small pocket made under the skin. The leads are usually placed in a vein near the collarbone, and then moved to the heart with the help of an X-ray machine. The leads touch the heart muscle on one end, and are connected to the pacemaker generator on the other end. The pacemaker is programmed to send signals to the heart, and settings can be changed at any time. Routine monitoring, some­times even by phone, makes sure the pacemaker is working properly. The battery in the generator lasts 5-10 years and must be replaced when it runs out.

Type of Pacemakers

• Single Chamber Pacemakershave one wire that is placed in the right upper chamber (atrium) or lower chamber (ventricle).
• Dual Chamber Pacemakershave two wires, one in the atrium and one in the ventricle.
• Biventricular Pacemakers have three wires, one in the right atrium, one in the right ventricle and a third in the left ventricle. These more complicated pacemakers take more time to implant, and can be used to improve pumping in patients with heart failure.
• Rate Responsive Pacemakers adjust the heart rate to a patient’s level of activity. They pace faster when a patient is exercising and slower when a patient is resting.

When are Pacemakers Used?

Pacemakers may be prescribed for a number of conditions, including:

• Bradycardia
  A condition in which the heart beats too slowly, causing symptoms such as fatigue, dizziness or Fainting spells.

• Atrial fibrillation (AFib)
  A common heart rhythm disorder in which the heart beats too fast and chaotically. Sometimes, people with AFib can also have slow rhythms. Medications used to control atrial fibrillation may result in slow rhythms, which are treated by pacemakers.

• Heart failure
  A condition in which the heartbeat is not strong enough to carry a normal amount of blood and oxygen to the brain and other parts of the body. A special pacemaker can be programmed to increase the force of heart muscle contractions. This is called “biventricular pacing” or “resynchronization” therapy.
  
  
  
  
  
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Cardiac surgeons now use most advanced minimally invasive heart valve replacement or repair surgery techniques for eligible patients.

 Minimally Invasive Heart Valve Replacement or Repair Surgery Techniques in India

The four valves inside the heart must swing open easily and then click shut tightly—about 60 times per minute—to keep blood pumping smoothly in the proper direction. But these hard-working, one-way valves often break down. The most common problems are leaks (regurgitation) and narrowing (stenosis).

Heart disease can produce these valve problems. For example, patients with an aortic aneurysm, a heart attack, or high blood pressure may develop aortic valve regurgitation. In this condition, also called insufficiency, the valve flaps (leaflets) do not close completely. This allows leakage of blood backward into the left ventricle after each heartbeat. Infection, inherited conditions, or other problems may also cause valve problems. 

If untreated, a faulty heart valve can trigger serious problems elsewhere in the heart. For example, patients who have mitral valve regurgitation (where the leaflets leak blood backward into the atrium) are at risk of arrhythmias, heart failure, or stroke. Mitral valve stenosis can cause heart failure or lung problems due to the backflow pressure.

Surgery is often the best solution for valve problems.|

Common Types of Valve Surgery

Your surgeon may recommend surgery to repair a damaged or diseased valve. Surgery is most often needed for the mitral valve or aortic valve on the more powerful left side of the heart. But some people need surgery on the tricuspid valve or pulmonary valve. Many valve procedures can be done with minimally invasive or robotic-assisted techniques that may limit pain and speed recovery.

we offer a full range of minimally invasive approaches (totally endovascular, mini-thoracotomy, port access, keyhole, and robotic-assisted) as well as standard open surgical procedures. All these terms describe how the surgeon reaches the heart valve to make the necessary repair—not the exact surgical repair itself. Learn more about robotic and minimally invasive 

Aortic Valve Surgery or Mitral Valve Surgery.

The purpose of valve surgery is to help your existing valve work better—either opening more fully or closing more completely. The most common valve surgeries performed include:

Valve Repair and Rreshaping

·     Your surgeon can use a variety of tools and methods to repair, reshape, trim, or otherwise modify the valve flaps to create a tighter seal or to enlarge the opening.

·     Any tears or holes in your valve can be patched or sewn back together to prevent leakage.

·     In another common technique to improve valve function, your surgeon may shorten or repair the cords or tendons inside the heart that attach to the valves. These cords, called papillary muscles and chordae tendineae, are sometimes ruptured or weakened by a heart attack or infection.

·         One or more of these repair procedures might be used to limit stenosis or regurgitation.

Annuloplasty

·         If the base of a mitral or tricuspid valve becomes enlarged, dilated, or damaged, your surgeon can strengthen this ring of tissue (called the annulus) by sewing in an O- or C-shaped annuloplasty ring at the valve base.

·         This synthetic ring provides a firmer foundation for the valve.

·         It also cinches up the loose opening, allowing the valve to seal more tightly and prevent regurgitation of blood into the atria. 

·         Annuloplasty can now be accomplished using minimally invasive techniques.

Mitral Prolapse Repair

·      

 

  If your mitral leaflets are weak or thickened, they may bulge backward with every heartbeat. In some cases, blood spills backward through the ballooning valve into the left atrium.

·         If prolapse is starting to cause symptoms, or if tests indicate future risks, your surgeon can remove a section of one or more leaflets to "tighten up" the leaflet(s) and prevent mitral regurgitation.

·         Another option for a floppy mitral valve is to insert an annuloplasty ring to strengthen the valve's base.

Mitral Balloon Valvuloplasty

·         If you have a certain type of mitral stenosis, your surgeon can guide a balloon-tipped catheter into the mitral valve and gently inflate it to force open the valve and improve blood flow.

·         The catheter is a wire-like tube that can be inserted through a leg artery and guided up to the heart, thus avoiding open surgery.

·         This procedure, called balloon valvotomy or valvuloplasty, is usually for milder stenosis with no regurgitation or calcification.

·         A valve replacement is often needed for more severe stenosis.

Repair or Replacement of Bicuspid Aortic Valve

·         About 1% to 2% of the population is born with two of their three aortic valve leaflets (cusps) fused together.

·         For many people this "bicuspid" aortic valve is no problem. But if your bicuspid valve is causing stenosis, your surgeon may recommend repair to separate the fused cusps.

·         If the problem is severe, you may need a valve replacement.

Aortic, Mitral,Pulmonary, or Tricuspid Valve Replacement

·         In severely diseased or damaged valves, replacement with a new mechanical or tissue (from pig, cow, or human donor) valve is sometimes recommended.

·         Your surgeon will provide details about the benefits of repair versus replacement and the trade offs between mechanical and tissue (biologic or bioprosthetic) valves.

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Minimally invasive & Robotic Surgery Heart Valve Surgery in India

Heart Valve Repair or Replacement Surgery

Blood is pumped through your heart in only one direction. Heart valves play a key role in this one-way blood flow, opening and closing with each heartbeat. Pressure changes on either side of the valves cause them to open their flap-like "doors" (called cusps or leaflets) at just the right time, then close tightly to prevent a back flow of blood.

There are 4 valves in the heart:

• Tricuspid valve
• Pulmonary valve
• Mitral valve
• Aortic valve

Nearly all of these operations are done to repair or replace the mitral or aortic valves. These valves are on the left side of the heart, which works harder than the right. They control the flow of oxygen-rich blood from the lungs to the rest of the body.

Valve Disease

If valve damage is mild, doctors may be able to treat it with medicines. If damage to the valve is severe, surgery to repair or replace the valve may be needed.

What is valve repair?

Valve repair can usually be done on congenital valve defects (defects you are born with) and has a good success record with treating mitral valve defects.

Here are some procedures surgeons may use to repair a valve:

• Commissurotomy, which is used for narrowed valves, where the leaflets are thickened and perhaps stuck together. The surgeon opens the valve by cutting the points where the leaflets meet.
• Valvuloplasty, which strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening.
• Reshaping, where the surgeon cuts out a section of a leaflet. Once the leaflet is sewn back together, the valve can close properly.
• Decalcification, which removes calcium buildup from the leaflets. Once the calcium is removed, the leaflets can close properly.
• Repair of structural support, which replaces or shortens the cords that give the valves support (these cords are called the chordae tendineae and the papillary muscles). When the cords are the right length, the valve can close properly.
• Patching, where the surgeon covers holes or tears in the leaflets with a tissue patch.

What is valve replacement?

Severe valve damage means that the valve will need to be replaced. Valve replacement is most often used to treat aortic valves and severely damaged mitral valves. It is also used to treat any valve disease that is life-threatening. Sometimes, more than one valve may be damaged in the heart, so patients may need more than one repair or replacement.

There are 2 kinds of valves used for valve replacement:

• Mechanical valves, which are usually made from materials such as plastic, carbon, or metal. Mechanical valves are strong, and they last a long time. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to take blood-thinning medicines for the rest of their lives.
• Biological valves, which are made from animal tissue (called a xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes, a patient's own tissue can be used for valve replacement (called an autograft). Patients with biological valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves, though, and they may need to be replaced every 10 years or so. Biological valves break down even faster in children and young adults, so these valves are used most often in elderly patients.

During valve repair or replacement surgery, the breastbone is divided, the heart is stopped, and blood is sent through a heart-lung machine. Because the heart or the aorta must be opened, heart valve surgery is open heart surgery.

What to Expect

The operation will usually be scheduled at a time that is best for you and your surgeon, except in urgent cases. As the date of your surgery gets closer, be sure to tell your surgeon and cardiologist about any changes in your health. If you have a cold or the flu, this can lead to infections that may affect your recovery. Be aware of fever, chills, coughing, or a runny nose. Tell the doctor if you have any of these symptoms.

Also, remind your cardiologist and surgeon about all of the medicines you are taking, especially any over-the-counter medicines such as aspirin or those that might contain aspirin. You should make a list of the medicines and bring it with you to the hospital.

It is always best to get complete instructions from your cardiologist and surgeon about the procedure, but here are some basics you can expect when you have valve repair or replacement surgery.

Day of Surgery

Before surgery, you may have an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest x-ray to give your surgeon the latest information about your health. You will be given something to help you relax (a mild tranquilizer) before you are taken into the operating room.

Small metal disks called electrodes will be attached to your chest. These electrodes are connected to an electrocardiogram machine, which will monitor your heart's rhythm and electrical activity. You will receive a local anesthetic to numb the area where a plastic tube (called a line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in a vein. The IV line will be used to give you the anesthesia before and during the operation.

After you are completely asleep, a tube will be inserted down your windpipe and connected to a machine called a respirator, which will take over your breathing. Another tube will be inserted through your nose and down your throat, into your stomach. This tube will stop liquid and air from collecting in your stomach, so you will not feel sick and bloated when you wake up. A thin tube called a catheter will be inserted into your bladder to collect any urine produced during the operation.

A heart-lung machine is used for all valve repair or replacement surgeries. This will keep oxygen-rich blood flowing through your body while your heart is stopped. A perfusion technologist or blood-flow specialist operates the heart-lung machine. Before you are hooked up to this machine, a blood-thinning medicine called an anticoagulant will be given to prevent your blood from clotting. The surgical team is led by the cardiovascular surgeon and includes other assisting surgeons, an anesthesiologist, and surgical nurses.

After you are hooked up to the heart-lung machine, your heart is stopped and cooled. Next, a cut is made into the heart or aorta, depending on which valve is being repaired or replaced. Once the surgeon has finished the repair or replacement, the heart is then started again, and you are disconnected from the heart-lung machine.

The surgery can take anywhere from 2 to 4 hours or more, depending on the number of valves that need to be repaired or replaced.

Recovery Time

You can expect to stay in the hospital for about a week, including at least 1 to 3 days in the Intensive Care Unit (ICU).

Recovery after valve surgery may take a long time, depending on how healthy you were before the operation. You will have to rest and limit your activities. Your doctor may want you to begin an exercise program or to join a cardiac rehabilitation program.

If you have an office job, you can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer.

Life after Valve Replacement

Most valve repair and replacement operations are successful. In some rare cases, a valve repair may fail and another operation may be needed.

Patients with a biological valve may need to have the valve replaced in 10 to 15 years. Mechanical valves may also fail, so patients should alert their doctor if they are having any symptoms of valve failure.

Patients with a mechanical valve will need to take a blood-thinning medicine for the rest of their lives. Because these medicines increase the risk of bleeding within the body, you should always wear a medical alert bracelet and tell your doctor or dentist that you are taking a blood-thinning medicine.

Minimally Invasive Valve Surgery

Minimally invasive heart valve surgery is a technique that uses smaller incisions to repair or replace heart valves. This means there is less pain. Minimally invasive surgery also reduces the length of the hospital stay and the recovery time.

Minimally invasive valve surgery can only be done in certain patients. This type of surgery cannot be done in patients

• With severe valve damage
• Who need more than one valve repaired or replaced
• Who have clogged arteries (atherosclerosis)
• Who are obese

In some cases, minimally invasive valve surgery can be done using a robot. Robotic surgery does not require a large incision in the chest. It is not available at all hospitals, and patients with severe valve damage cannot have the procedure. The Texas Heart Institute has a robot.

With robotic surgery, the surgeon has a control console, a side cart with 3 robotic arms, a special vision system, and instruments. A computer translates the surgeon's natural hand and wrist movements made on the control console to instruments that have been placed inside the patient through small incisions. The robot's controls can read even the tiniest of movements the surgeon makes. Robotic surgery can reduce the time it takes to do valve surgery, as well as shorten the hospital stay and recovery time.

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