Robot-assisted mitral valve surgery

Written by: Mr Paul Modi
Edited by: Laura Burgess

Thanks to innovative technology such as the da Vinci Surgical System®, patients are able to undergo mitral valve reconstruction using minimally invasive and robotic techniques. This leaves them with much less pain and the chance of infection, and much faster recovery than conventional surgery (sternotomy).

Top cardiothoracic surgeon Mr Paul Modi is the only mitral valve surgeon in the UK who uses the da Vinci® robotic system in his hospital. Here he explains when mitral valve surgery is necessary and what happens during ‘robotic’ surgery.

What causes mitral valve disease?

There are lots of causes of mitral valve disease, from degenerative causes (such as Barlow’s disease and fibro-elastic deficiency) through to infection (endocarditis) and rheumatic fever. Degenerative mitral valve disease often occurs when the anchoring strings (or chords) that hold the valve inside the heart break causing blood to leak backwards.

The increased pressure of blood in the lungs and the extra work that the heart must do which results from this leads to patients feeling breathless and tired on exertion. We know that early corrective surgery to reconstruct the valve results in resolution of these symptoms and restoration of life expectancy to normal.


When is mitral valve surgery necessary?

The strongest indications for surgery are either symptoms, such as shortness of breath or tiredness, or a decline in heart function. Other indications for surgery include an irregular heartbeat (atrial fibrillation) and high blood pressure in the lungs.

It is generally recognised that surgery early in the course of the disease leads to better long-term outcomes and this is even true in patients who have no symptoms.

What is robotic mitral valve surgery?

This is the very least invasive form of surgery for the mitral valve. The operation is done through four 8mm incisions using the da Vinci® robot from Intuitive Surgical. The procedure is performed on the right-hand side of the chest - most people think it is on the left because the heart is on the left. We still use the heart-lung machine because we have to stop the heart to get inside to do a delicate valve reconstruction.

Why is a robot used during the surgery?

It’s not a ‘robot’ in the common meaning of the word as it’s not an autonomous machine that makes a decision for itself. The surgeon sits at a console and moves the arms, so it doesn’t do anything on its own. Telemanipulation is a better way to describe it, this being a way of transmitting hand movements from the surgeon’s console to a remote robotic device. It’s essentially a way of minimising the surgical trauma that patients may otherwise be subject to.

What are the options available for mitral valve surgery?

There are three surgical options for mitral valve repair:

1) Sternotomy – uses a 6-9-inch incision on the front of the chest to divide the breastbone and it takes 8-12 weeks to return to normal activities after this, of which about a week is in hospital. However, it sounds worse than it is and is, in fact, very well tolerated and used for the majority of heart operations.

2) ‘Mini mitral’ (short for minimally invasive mitral) procedure – uses a 4cm incision on the right-hand side of the chest and is associated with a 3-6 week recovery period (but may be quicker than this is some patients).

3) Robotic mitral valve surgery – uses four 8mm incisions and recovery takes 2-3 weeks. This is the very least invasive form of treatment for mitral valve reconstruction.

If you would like to discuss your surgery options with Mr Modi, do not hesitate to make an appointment today.

By Mr Paul Modi
Cardiothoracic surgery

Mr Paul Modi is a world-leading consultant cardiac surgeon who specialises in minimally invasive and robotic mitral valve and atrial fibrillation surgery, robotic and off pump coronary artery bypass surgery and minimally invasive myxoma surgery. He is one of only a small number of surgeons in the UK who performs minimally invasive mitral valve and atrial fibrillation surgery and is currently the only British heart surgeon performing robotic mitral valve repair and robot-assisted coronary artery surgery. He was the first surgeon in the UK to perform totally endoscopic robotic mitral valve repair.

Mr Modi graduated from Leeds University in 1994 and soon after became a Fellow of the Royal College of Surgeons of England. He then spent two years as a British Heart Foundation research fellow at Bristol University before being awarded the prestigious Doctorate in Medicine (MD) in 2003 for research into ways of better protecting childrens' hearts during open-heart surgery. 

Mr Modi trained in cardiothoracic surgery in the UK, before spending a year as a clinical instructor (consultant/attending surgeon) in the USA, where he worked alongside Dr Randolph Chitwood Jr. at East Carolina Heart Institute, learning minimally invasive and robotic cardiac valvular surgery, and atrial fibrillation surgery techniques. Uniquely, he was also trained by Dr Doug Murphy, the current world lead in robotic mitral valve surgery in Atlanta, USA.

Mr Modi went on to complete super-specialist training in minimally invasive valve and robotic coronary surgery with Dr Sam Balkhy in Chicago, USA, Professor Frederich Mohr in Leipzig, Germany, and with Dr Hugo Vanermen in Aalst, Belgium.

Mr Modi currently works at the Liverpool Heart and Chest Hospital, the second biggest specialist centre for cardiac surgery in the UK, where he brings with him the pioneering techniques that he learned overseas.

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