New Technique for Mitral Valve Surgery
MADISON — A UW Health cardiovascular surgeon is closing in on a solution for patients who are too sick to have mitral valve surgery.
If you're one of the 40,000 patients every year who need mitral-valve surgery, you have no choice but to be on a heart-lung bypass machine during the procedure. But that fact eliminates surgery as an option for many elderly and extremely sick patients whose damaged hearts are often too weak to survive the operation.
Dr. Lucian Lozonschi is testing the new approach, called transcatheter mitral-valve replacement, and it has the potential to make mitral valve replacement surgery an option for sicker patients.
The International Society for Minimally Invasive Cardiothoracic Surgery agrees. They recently awarded Lozonschi the 2008 Robert Emery Young Investigator Award for his manuscript describing the procedure.
"We can target initially the patients with sickened hearts and multiple medical problems, offering them hope," explains Lozonschi. "These are individuals who would otherwise be left to die of their heart valve disease, people who couldn’t survive the standard operation."
Mitral valve replacement can be performed through small incisions, sometimes with the help of a surgical robot and even without stopping the heart, but it can’t be performed without heart-lung bypass.
Lozonschi delivers the replacement valve through a catheter that is placed through a small chest incision and guided through the tip of the heart - while the heart is beating - to the site of the damaged valve. Once there, the replacement valve expands into place, opening up what had been blocked or damaged. It's the same kind of technique cardiologists have been using to place umbrella stents in patients with clogged arteries.
Lozonschi developed the technique along with Dr. Georg Lutter, a cardiovascular surgeon and professor in Kiel, Germany. In the last months, Lozonschi has performed the transcatheter procedure on several pigs at the University of Wisconsin, all of which survived the surgery.
"The main success here is replacing the whole valve without the heart and lung machine," says Lozonschi. "In the long term, this could be a milestone development in the field of endovascular valve therapy."
Not only is the process potentially less expensive, but patient trauma and recovery time is significantly shorter as well.
If clinical trials in animals and humans prove successful, Dr. Lozonschi expects that the procedure could be available as standard treatment in the next seven to eight years.
Date Published: 07/01/2008