Mitral Valve Repair

Each year, the heart surgeons at Raney Zusman Medical Group, exclusive heart surgeons to Hoag Hospital, repair more heart valves  than any other medical center in Orange County.  This expericence designates Hoag Hospital as one of the top hospitals on the West Coast for this type of surgery. 

When the mitral valve is not working properly, there are two options to correct the problem.  Traditionally, surgeons would remove the diseased valve and replace it with an artificial valve.  Now, experts generally agree that whenever possible, a heart valve should be repaired.  The surgeons at Raney Zusman Medical Group specialize in mitral valve repair and will attempt to repair the mitral valve whenever possible. 

"Valve repair surgery offers substantial advantages over replacement since it leaves a patient's own living tissue functioning normally," explains Aidan Raney, M.D., director of cardiac surgery at Hoag hospital.  "Repair gives patients an 80 percent chance that they may go the rest of their life without any further surgery on that valve, and it eliminates the need for the medication therapy associated with traditional valve replacement surgery." 

Yet despite its advantages, most mitral valve surgery patients nationwide receive valve replacement instead of mitral valve repair, as the repair surgery requires a significantly higher level of training and complex surgical experience not available at all hospitals.  The surgeons of Raney Zusman Medical Group repair more than 90 percent of patients with degenerative mitral valve disease instead of replacing the valve.  Please read the following sections for more information on what makes mitral valve repair surgery unique at Raney Zusman Medical Group.

Excellence in Complex Valve Repair Surgery
Each year, the cardiovascular surgeons of Raney Zusman Medical Group repair more heart valves than any other medical center in Orange County - experience that designates Hoag Hospital as one of the top hospitals on the West Coast for this type of surgery.  Combining the expertise of the hospital's exclusive cardiovascular surgical team and an internationally known cardiologist specializing in echocardiography with state-of-the-art technology, Hoag offers patients world-class valve surgery at a dedicated cardiac care center.


Why Mitral Valve Repair instead of Mitral Valve Replacement?
Mitral Valve repair has been proven in multiple studies to be superior to valve replacement in terms of surgical mortality, durability of repair, thromboembolism, anticoagulation, ventricular function and long-term survival.  The 2006 guidelines from the American Heart Association and the American College of Cardiology state that “mitral valve repair is recommended over mitral valve replacement in the majority of patients with severe chronic mitral regurgitation who require surgery, and patients should be referred to surgical centers experienced in mitral valve repair.”

Despite this data, according to the Society of Thoracic Surgeons database, only 50% of isolated mitral valve procedures consist of repair.  In our hands, the reparability rate of degenerative mitral valve cases is 90 to 95%.


Expertise in Mitral Valve Repair
Excellent results in surgical care are built on a good foundation of surgical skill followed by a large number of cases to reinforce these skills. The surgeons at Raney Zusman Medical Group have completed top-notch residency training at Stanford (Dr.'s Raney and Zusman) and UCSD (Dr. Joyo) medical centers.

In the early 1990's, the surgeons began to perform complex mitral valve repairs.  To learn the techniques, the surgeons traveled to France to study with the founding pioneer of mitral valve repair surgery, Dr. Alain Carpentier.  They also studied under Dr. Carlos Duran, another pioneer in mitral valve repair from the north of Spain.  The accomplishments of Dr. Raney, Dr. Zusman, and Dr. Joyo were recently honored as Dr. Carpentier returned to the United States to speak at the opening of the Hoag Heart Valve Center.

In addition to superior training, our surgeons have performed a large volume of mitral valve repairs, averaging 80 to 100 cases annually.  Every mitral valve repair poses a unique challenge, and this experience allows our surgeons to correctly assess the mitral valve and plan an effective surgery to eliminate the problems with valve function.


Echocardiography Teamwork at Hoag Hospital
The echo-surgery teamwork between our surgeons and Dr. Pravin Shah provides for better outcomes and increased survival rates. Dr. Shah is a cardiologist and internationally renowned pioneer of echocardiography.  Under this arrangement, Dr. Shah performs echocardiography on the patient before, during, and after surgery.  

The preoperative echo provides the surgeon with an understanding of the problem from a functional view, which essentially gives information about what is wrong when the heart is actually working. The surgeon can then tailor his operative approach to ensure that this problem is fixed.

Once the repair is complete, Dr. Shah will again assess the function of the valve by echocardiography.  This allows Dr. Shah and our surgeons to assess the function of the heart when it is actually beating and filled with blood.    At this point, 95% of the valves are fully repaired, and the echo-surgery team is assured that the repair is successful.  In addition, a small number of patients may show abnormal blood flow through the valve.  In these patients, our surgeons can revise the initial repair and ensure success before the patient leaves the operating room.  In a recent publication, Dr. Shah and Dr. Raney reported that of 207 mitral valve repairs between 2000 and 2005, 203 patients had successful repair or revision of initial repair, with only mild regurgitation from the valve after surgery.  In 4 cases, the patient underwent successful mitral valve replacement after it was determined that a repair of the native valve could not be completed.

The echocardiographer will follow the patient after the surgery has been completed and perform a post-operative echocardiogram to ensure that the flow of blood through the mitral valve has not changed since the operation.


Excellent Results
Dr. Aidan Raney and Dr. Pravin Shah recently published a paper in the Journal of Heart Valve Disease demonstrating better outcomes with echo-surgery teamwork. As stated in the paper:

"Mitral Valve repair was attempted in 68 patients and successful in 67 patients (98.5%). Repair was unsuccessful in only one patient, who received a mitral valve replacement."


Internationally Renowned Surgeons
The surgeons of Raney Zusman medical group have completed trips to India, Paris, Thailand and London to give lectures on mitral valve repair. They have also completed multiple scientific papers on mitral valve repair, and host the bi-annual International Valve Symposium in Newport Beach.  (Pictured at left are Dr. Raney and Sir Magdi Yacoub from the 2005 International Valve Symposium).

If you have questions about the specifics of mitral valve repair or would like to know if you are a candidate for mitral valve repair surgery, please call (888) 565-8224 to schedule a consultation.