Surgery Still the Standard | MedStar Health

Surgery: Still the Standard

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2017 Fall

Most patients with mitral valve disease today suffer from primary, or degenerative, mitral regurgitation (MR). A structural problem involving the leaflets, annulus or chordae, degenerative MR is one of the most common cardiovascular diseases in the United States and Europe today. And the front-line treatment remains surgery.

Cardiac surgeons at MedStar Heart & Vascular Institute (MHVI) have more options than ever, including open surgery or minimally invasive procedures using a mini-thoracotomy or mini-sternotomy, backed up by new and innovative interventional cardiology approaches for nonsurgical candidates. In some cases, our specialists have even appropriated TAVR techniques to fix previously replaced but failing mitral valves.

With the full suite of proven and promising technology at their fingertips, our surgeons can match each patient with the best therapy for optimal outcomes. Matched with landmark research in the field of mitral valve surgery, MHVI cardiac surgeons are re-defining the indications for not only when to operate on patients with mitral regurgitation, but also the variety of techniques used.

Replace or Repair?

At MHVI, the surgical choices are many. And while some cases may be clear-cut, others depend upon the judgment of the cardiac surgeon.

Ammar Bafi, MD, cardiothoracic surgeon, is one of the busiest and most experienced mitral valve repair specialists in the United States today.

“Over the course of my career, patients with degenerative MR typically have the best possible outcomes with repair,” says Ammar Bafi, MD, a cardiothoracic surgeon with MedStar Washington Hospital Center and one of the busiest and most experienced mitral valve repair specialists in the United States today. “Overall, repair is associated with a lower operative mortality rate, longer survival, better preservation of left ventricular function and fewer prosthetic-related complications than replacement.”

At the Hospital Center, hub of MHVI, more than 98 percent of degenerative mitral valves are repaired successfully. However, in some instances, replacement can be equally effective and long-lasting. The choice of repairing or replacing, and the eventual success of either procedure, often boils down to patient selection.

“For patients with ischemic disease,” says Dr. Bafi, “replacement may work better. That’s also the case for patients with functional mitral regurgitation, after medical therapies and specialized electrical physiology procedures have failed. For others, it just depends upon which approach is going to produce the best outcome for that individual.”

“Our MHVI valve program is one of the nation’s highest volume centers for mitral valve surgeries, far surpassing most other institutions,” says Dr. Bafi. “The key to success is early referral to an experienced site for the most timely intervention and best results.”

Repair vs. Replace

Overall repair is associated with:

  • A lower operative mortality rate
  • Longer survival
  • Better preservation of left ventricular function
  • Fewer prosthetic-related complications

Replacement may work better for patients that have:

  • Ischemic mitral regurgitation
  • Functional mitral regurgitation of other causes
  • Mitral stenosis