Valve Surgery
Experience, Leading-Edge Approaches Key
The University of Virginia Health System's outcomes for heart-valve surgical patients exceed national averages as compiled by the Society of Thoracic Surgeons' (STS) National Adult Cardiac Surgery Database.
These outcomes are likely based on UVA's significant experience in heart-valve procedures. For instance, UVA ranked in the 94th percentile nationally for valve surgery volume and the 86th percentile for combined valve surgery and CABG volume from July 2006 to June 2007, based on data from the STS database.
"We have tremendous expertise in heart-valve surgery," says Irving Kron, M.D., Professor of Surgery and Chair of UVA's Department of Surgery.
UVA exceeds national averages for all STS participants in risk-adjusted in-hospital mortality and major complications for mitral-valve repair, aortic-valve replacement and aortic-valve replacement combined with coronary artery bypass grafting (CABG) for the time period between January 2007 and June 2007, the most recent time period with available data.
The surgeons performing heart-valve operations at UVA include Kron; John Kern, M.D., Associate Professor of Surgery; Gorav Ailawadi, M.D., Assistant Professor of Surgery; and Ben Peeler, M.D., Assistant Professor of Surgery.
UVA's program is driven by an experienced multidisciplinary team with strengths in valve repair and leading-edge techniques. Later this year, UVA will be one of eight hospitals participating in the first national clinical trials for heart-valve surgery, which are funded by the National Institutes of Health.
Multidisciplinary Diagnosis and Treatment
UVA brings together surgeons, cardiologists and radiologists to diagnose and treat patients with heart-valve problems. UVA is unique because it has extensive experience with treating valve problems in all age groups from newborns to the elderly, Peeler says. UVA is developing a heart-valve clinic to combine visits with all of the members of the treatment team into one or two visits, says Kern.
UVA's cardiac surgeons work closely with nationally recognized experts in 3-D echocardiography, including Associate Professor of Medicine John Dent, M.D., and Associate Professor of Medicine Robert Battle, M.D. The echocardiogram helps surgeons evaluate the exact nature of a patient's valve problem, determine whether surgery is necessary and evaluate the effectiveness of heart-valve procedures, says Ailawadi.
Following heart-valve procedures, patients recover in UVA's Thoracic-Cardiovascular Postoperative ICU, which last year became one of only 80 critical-care units in the country to receive the Beacon Award for Critical Care Excellence. The American Association of Critical-Care Nurses chooses recipients based on criteria that include patient outcomes and the use of evidence-based practices in providing care.
Emphasis on Heart-Valve Repair
Whenever possible, UVA's surgeons prefer to repair damaged heart valves rather than replace them. The life expectancy of a repaired native valve is generally longer than the 10- to 20-year lifespan of an artificial or animal valve, Ailawadi says. Repairing an existing valve also improves mortality rates for patients and doesn't require them to take blood thinners such as Warfarin, Kron says. UVA tailors treatment based on the patient's comorbidities, age and activity level. For instance, UVA surgeons are more likely to attempt to preserve the valve in a younger patient, Ailawadi says, to spare them another procedure down the road. UVA also has extensive experience in re-operations on heart valves that have previously had procedures performed on them, Ailawadi says.
UVA also has a long history of working to repair heart valves. For instance, Kron says, UVA surgeons have developed a technique to treat ischemic regurgitation that prevents the heart muscle from pulling on the valve. UVA also has significant experience in repairing aortic valves damaged by aortic dissection, Kern says, as well as repairing bicuspid aortic valves.
Percutaneous Valve Repair
UVA is also on the leading edge of new techniques for percutaneous valve repair. "UVA is examining endovascular, percutaneous repair of mitral-valve regurgitation through the Endovascular Valve Edge-to-Edge Repair Study (EVEREST II), which uses the MitraClipTM device. UVA is the only hospital in Virginia participating in the multi-center trial," says D. Scott Lim, M.D., an interventional cardiologist and Assistant Professor of Medicine.
To implant the clip, a catheter is inserted into a leg vein and is threaded to the heart, where one or more clips are placed on leaking portions of the mitral valve. "The patient's heart beats during the procedure, which allows the treatment team to pinpoint where the valve is leaking and where a clip is required," says Lim, the principal investigator for the study at UVA. "Real time 3-D transesophageal echocardiograms help the cardiology team visualize where to place the clips."
Patients in the study are randomized 2:1 to receive either the MitraClip or traditional open-heart surgical valve repair or replacement. Inclusion criteria include moderate-to-severe or severe mitral regurgitation from degenerative or functional mitral-valve disease; exclusion criteria include ejection fraction of less than 25 percent, endocarditis and rheumatic heart disease.
UVA expects to enroll patient volunteers in the study through the end of 2008, Lim says.
To refer a patient for heart-valve repair or replacement, call UVA Physician Direct at 800-552-3723.