CINCINNATI — Almost 3% of all Americans, and 13% of Americans 80 and older, have heart valve disease.
People with heart valve disease may have hardened or leaking valves, and feel fine, at first but, eventually, they may have shortness of breath, fatigue, lightheadedness, or even chest pains.
Surgeons have used endoscopic procedures to repair one, or even two valves but, three has traditionally been an open procedure.
"It's a major surgery, not only because of the central incision and you need your chest bone crack, but because we need a cardiopulmonary bypass, and we need to arrest the heart to work inside the heart," said Dr. Tommaso Hinna Danesi, cardiac surgeon and endoscopic cardiac surgeon at the University of Cincinnati.
Each of us has four heart valves that keep our blood circulating in the right direction.
If those valves don't work properly, blood flow is restricted, which can lead to heart failure, blood clots and stroke.
Now for the first time in the United States, Dr. Hinna Danesi has operated on three valves through a one-inch incision, replacing a patient's aortic and mitral valves, and repairing her tricuspid valve.
Doctors say the endoscopic approach reduced the surgical time by as much as 50% and allowed them to keep some patients' hearts beating during surgery.
"If you think to an elderly and fragile patient, maybe more gentle surgical access might be the difference between being alive or death from an operation," he added.
"So, it's a big advantage."
That patient, 63-year-old Karyn Russell, was discharged from the hospital a week after surgery.
Clinical trial underway
Researchers from the Cardiothoracic Surgical Trials Network launched a multi-year randomized clinical trial with 401 patients being treated for worsening mitral valve regurgitation with mild to moderate tricuspid regurgitation.
The surgical procedures took place at 39 medical centers in the United States, Canada and Germany.
Researchers found that among patients who had the combined mitral valve and tricuspid valve repair, just 3.9% developed severe regurgitation, died, or needed a reoperation, compared to 10.2% who had the mitral valve surgery alone.
Researchers observed no significant differences between patient groups in the number of major cardiovascular events, changes in functional status, or quality of life, but 14.1% of patients who had the surgery and tricuspid annuloplasty needed a permanent pacemaker, compared to 2.5% who had the surgery alone.