Leading Expert in Minimally Invasive Valve Repair Weighs the Evidence
(Wynnewood, Pa.) — One of the most common heart diseases in the United States – mitral valve prolapse – is incorrectly treated about half of the time, according to Scott Goldman, MD, Chief of Thoracic and Cardiovascular Surgery at Lankenau Medical Center.
Mitral valve prolapse, a valve disorder that can interfere with the flow of blood through the heart’s chambers, affects approximately three percent of the population. Most with the disease do not require intervention, while some need prescribed medication. In approximately 10 percent of cases, surgery is recommended. Of those patients who are treated surgically, half will have a valve repair, while the other half will receive an artificial valve. Most will undergo a sternotomy – an invasive procedure requiring a 10 to 12-inch incision through the breast bone, and a complex recovery.
According to Dr. Goldman, one of the nation’s leading experts on mitral valve disease, the evidence in favor of surgical repair vs. replacement is overwhelming, as is the evidence favoring a minimally invasive approach.
“Repairing the heart valve, as opposed to replacing it, offers significantly better short and long term outcomes,” said Dr. Goldman. “A good repair is likely the only intervention a patient will need in his or her lifetime. With valve replacement, while a mechanical valve made from metal and plastic may be durable, there is a higher incidence of developing blood clots, and long term treatment with anti-coagulant medication – or blood thinners – is a necessity. And while using a replacement valve made from animal tissue – a pig or a cow – does not require the use of anti-coagulant medication, the lifespan of the valve is typically just 12 years.”
“Far too many patients are getting valve replacement surgery when valve repair would make much more sense,” states Dr. Goldman. “And far too many are undergoing invasive surgery when a minimally invasive approach would be significantly more beneficial.”
Dr. Goldman is one of just a handful of surgeons across the country performing minimally invasive mitral valve repair, as well as minimally invasive valve replacement. In fact, virtually every mitral valve surgery performed by Dr. Goldman utilizes a minimally invasive approach. Ninety percent of his mitral valve surgeries involve valve repair as opposed to replacement.
This minimally invasive approach requires a one-inch incision under the right arm. There is no need to break ribs or cut through any muscle, and recovery is four times faster than when an invasive approach is taken. Dr. Goldman performs most of his procedures using an endoscope – which he views as the equivalent to robotic surgery. Some of his surgeries are performed robotically.
Dr. Goldman estimates that 10 percent of cardiac surgeons across the country are performing 90 percent of mitral valve surgeries, and most will perform only about ten a year. Dr. Goldman and his regular operating room team – completely intact for 15 years now – performs 100 mitral valve repairs annually, making Dr. Goldman one of the most experienced mitral valve surgeons in the United States.
Patients travel from New York State, New England and Florida, and as far as Alaska and Colorado, to seek Dr. Goldman’s expertise. At least twice each month, surgical teams from across the country visit his operating room for training. Lankenau Medical Center is one of the nation’s premier heart centers, and has one of the largest cardiothoracic surgical programs in the U.S.
“Our outcomes are excellent,” reports Dr. Goldman. “With minimally invasive surgery, we can tell patients that recovery is in weeks instead of months. I recently had a patient playing tennis one month after surgery.”
Dr. Goldman believes that in the not too distant future, mitral valve surgeries will be performed without any incisions. “The future of cardiac surgery will be increasingly less traumatic and less invasive,” he said. Over the last two years, Goldman and his team have developed an even more advanced technique for repair – one that does not require removal of the valve tissue.
In May, Dr. Goldman made two major presentations at the Mitral Valve Enclave in New York City – an international gathering of leading cardiac surgeons from around the world. In one presentation, he shared data from the 600 minimally invasive mitral valve repairs he has performed over the past ten years. The second presentation focused on a brand new device developed by the Goldman team to facilitate minimally invasive mitral valve repair even more effectively.
Despite the evidence and benefits of valve repair, nearly half of the surgical procedures performed in the U.S. to correct mitral valve prolapse continue to be replacement of the valve. “Where a patient chooses to have his or her mitral valve prolapse fixed will greatly affect what course of treatment is prescribed,” said Dr. Goldman. “Leading heart centers that have access to the latest medical data will overwhelmingly support repair of the valve, rather than replacement.”
Lankenau Medical Center, a member of Main Line Health, is recognized as a national leader in advancing new options to diagnose and treat illness, protect against disease and save lives. Located on a 93-acre suburban campus just outside of Philadelphia, Lankenau Medical Center is a 389-bed, not-for-profit teaching hospital that includes one of the nation’s leading cardiovascular centers; the Lankenau Institute of Medical Research, one of the few freestanding hospital-associated research centers in the nation; and the Annenberg Conference Center for Medical Education. Lankenau offers state-of-the-art services from cancer care to maternity care. Lankenau is ranked as number six in Pennsylvania and number four in the Philadelphia metro area in U.S. News & World Report’s Best Hospitals. Lankenau Medical Center is also ranked nationally for diabetes and endocrinology, and is high-performing in eight specialties: cardiology & heart surgery, diabetes & endocrinology, gastroenterology & GI surgery, geriatrics, neurology & neurosurgery, orthopedics, pulmonology and urology. Lankenau has achieved The Joint Commission’s Gold Seal of Approval for stroke care and breast cancer care and is one of the nation’s Top Performing Hospitals for heart attack, heart failure, pneumonia and surgical care. Lankenau has also been ranked for multiple years as one of the top 50 cardiovascular hospitals in the nation by Truven Health Analytics. Lankenau has earned Magnet® designation for the third time for its superior nursing staff.
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