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Mitral valve repair

Despite the growing body of evidence favoring mitral valve repair for the treatment of patients with moderate to severe mitral regurgitation, nearly 50 percent of all cases in the United States still are treated with mitral valve replacement. UF cardiac surgeons successfully employ valve repair surgery in more than 90 percent of patients presenting with mitral regurgitation without mitral stenosis.

“When we do a repair, we preserve all the natural structures of the heart, including the chordae tendinae that suspend the mitral valve to the papillary muscles that make the valve work properly,” said Chuck Klodell, MD, UF College of Medicine associate professor of thoracic and cardiovascular surgery. “Although this requires more patience and slightly more time in the OR due to the meticulous surgical techniques involved, it ultimately results in better long-term outcomes, quality of life and longer lives for the patients.”

By avoiding mechanical replacements whenever possible, surgeons also bypass the need to prescribe patients life-long regimens of Coumadin or other blood thinners. Since mechanical mitral valves require high levels of Coumadin, patients treated with valve repair are at a lower risk for bleeding or clotting events than patients with mechanical valve replacement. Klodell said this can be a problem in the long term. If patients with valve replacement do not properly regulate their Coumadin, they constantly will oscillate between increased risk of bleeding and risk of stroke.

“This is just one more reason that valve repair should be considered the first option in any leaking mitral valve,” said Klodell.

Because UF Health is an academic medical center, Klodell said the multidisciplinary UF cardiac team is better equipped than most other centers to deal with mitral valve repair, with easier access to advanced technologies, techniques and training.

“Our entire team is in tune with the importance of repair for the patient. From the initial visits with the cardiologists, who are extremely facile with echocardiography and the imaging needed in the planning of how to repair these valves, to the anesthesiologists, perfusionists, OR staff and highly specialized surgeons – all trained in minimally invasive valve surgery – we are ideally suited to be at the forefront of repairing as many of those leaky valves as possible,” Klodell said.

Klodell emphasized that the notion that valve repair surgery has to be a terrible event in one’s life is completely outdated.

“Our ultimate concern is the patient’s comfort and overall experience, from their initial clinic visit through surgery and post-operative care in the ICU to pain management and following up with their primary care physicians,” said Klodell. “We focus on blood conservation and avoidance of blood- or blood-component transfusion, and we place a special emphasis on the patient’s expectations of pain control, providing multiple options to keep them comfortable and make this a positive life experience.”

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