46 Affected person Questions Answered by Dr. Marc Gillinov

Fantastic!

Throughout our current affected person webinar, “3 Inquiries to Ask Earlier than Mitral Valve Surgical procedure”, I obtained 46 questions that we didn’t have time to reply through the reside occasion. That mentioned, Dr. Marc Gillinov, who’s the Chairman of Cardiac Surgical procedure on the Cleveland Clinic and the featured speaker of the webinar, typed up solutions to every affected person query to assist educate our affected person neighborhood.

Query #1: Michael asks, “I have already got a TAVR and now want a TMVR. I do have a hoop within the mitral valve that was put in in 2005 each the valve and the ring are Edmonds Life science merchandise. It’s a versatile and full ring. What ought to I do know?”

If the mitral valve ring is versatile, TMVR will not be potential. — Dr. Marc Gillinov

Query #2: Deena asks, “If a severely calcified MV restore was profitable, what’s the “likelihood” it’s going to proceed to calcify and require one other restore?”

Impossible. — Dr. Marc Gillinov

Query #3: Laura asks, “I had a mitral valve restore by Dr. Gillinov in 2019 with a hoop. Will I at all times have to take antibiotic previous to dental procedures. How about 81 mg ASA? Thanks. I’m listening to this as a result of my 22 12 months previous daughter has average regurgitation. I pray she by no means wants surgical procedure.”

Sure. Antibiotics with dental and take aspirin. — Dr. Marc Gillinov

Query #4: Jan asks, “My mitral valve will want restore as a result of regurgiation. I’ve a pig worth and 5 stents. Most just lately had a carotid-carotid bypass w/prosthetic, carotid subclavian transposition and a zone O TBE. can a mitral be accomplished with out open process in at this time’s world? Eco in three weeks to verify on issues.”

Could also be potential with a MitraClip. — Dr. Marc Gillinov

Query #5: Michael asks, “I had rheumatic fever as youngster. Will the illness even have a major impact on the left aspect valves?”

Normally not. — Dr. Marc Gillinov

Query #6: Prabhjot asks, “If a affected person has a mitral stenosis and already carried out a Balloon Valvuloplasty twice what’s the probabilities of getting it accomplished once more. Age is 31 with no different issues?”

Would get surgical placement of a brand new valve. — Dr. Marc Gillinov

Query #7: George asks, “I had mitral valve repaired on the Cleveland clinic in 2013 and had to return and get a substitute pig valve in 2017 and at present no noticeable points. How lengthy do the valves (pig) final ? I’m 66.”

Normally round 10 years. — Dr. Marc Gillinov

Query #8: Nameless asks, “Are you able to clarify how grading of valve regurgitation works?”

Best grading system is 0-4, with 4 being extreme regurgitation. — Dr. Marc Gillinov

Query #9: Suzi asks, “Can an individual who’s a hemophilia provider be on blood thinner for a mechanical mitral valve substitute?”

Wouldn’t suggest that. — Dr. Marc Gillinov

Query #10: John asks, “Have we made any progress prior to now 12 months in repairing rheumatic mitral valves. My spouse is a affected person of Dr. Unai and now we have been watch and wait secure however she’s going to want each an aortic and mitral substitute or restore ultimately.”

More often than not, substitute is healthier on this setting. — Dr. Marc Gillinov

Query #11: Robin asks, “Ought to one take antibiotics if have mitral worth leak earlier than have enamel cleaned and if that’s the case what antibiotics?”

Solely you probably have had surgical procedure. — Dr. Marc Gillinov

Query #12: John asks, “Can my spouse solely have the mitral changed or repaired if the aortic valve is dangerous however possibly not dangerous sufficient to danger a twin valve surgical procedure?”

Higher to repair the whole lot that’s damaged. — Dr. Marc Gillinov

Query #13: Michael asks, “How does afib affect resolution making for mitral valve restore and substitute?”

Favor restore and including a biatrial maze process. — Dr. Marc Gillinov

Query #14: Paul asks, “I had robotic mitral valve restore surgical procedure 10 years in the past…. Does that impact my different valves over time? My aortic root is measuring 4.0 in my most up-to-date echocardiogram. It appears to have worsened virtually yearly. My heart specialist tells me to not fear about it, but it surely’s at all times on my thoughts.”

Mitral valve restore doesn’t have an effect on the aorta or aortic valve. Your aorta could be very unlikely to succeed in 5 cm, which is the scale of an aneurysm. — Dr. Marc Gillinov

Query #15: John asks, “Would my 45-year-old, skinny, in any other case wholesome spouse be a candidate for minimally invasive mitral valve surgical procedure?  If that’s the case, can a restore be accomplished with robotic surgical procedure?”

Seemingly sure, however want applicable preoperative screening with CT scan and coronary angiogram. — Dr. Marc Gillinov

Query #16: Kam asks, “For mitral valve restore are you able to talk about professionals / cons of robotic vs. mini-thoracotomy utilizing direct imaginative and prescient.”

With the robotic, higher visualization and smaller incisions. However the mini-thoracotomy can be an excellent method in skilled fingers. — Dr. Marc Gillinov

Query #17: George asks, “When are you aware when it’s time for a substitute of your mitral valve?”

Based totally upon the echocardiogram, together together with your scientific standing and signs. — Dr. Marc Gillinov

Query #18: Kathy asks, “Do I want to come back again to Cleveland after I’ve accomplished profitable surgical procedure? It has been three years since my surgical procedure and I am going to a significant Los Angeles hospital now for care? I needed to have a pacemaker put in after my surgical procedure in Cleveland. However am doing high-quality. Ought to I nonetheless verify into Cleveland in individual?”

We’d be joyful to see you, however so long as you might be getting a great echo yearly, there is no such thing as a compelling have to return to see us. — Dr. Marc Gillinov

Query #19: Allen asks, “For a affected person with posterior leaflet prolapse with flail do you typically carry out a sliding restore over the triangular resection approach?”

The sliding restore is a variant of resection used to cut back the peak/quantity of leaflet. I carry out about 50% of resections with a sliding restore and 50% as easy triangular resections. I tailor it to the affected person’s valve. — Dr. Marc Gillinov

Query #20: Nameless asks, “Hello, After surgical procedure we’re instructed to take antibiotics earlier than dental cleanings and procedures. What’s the means the plaque and different dangerous stuff enter your physique, is it by swallowing or by way of the bloodstream by the dental devices making your gums bleed? Is there a distinction in danger relying on process similar to tooth removing or cleansing?”

Micro organism can enter by way of the gums with any dental process. After a mitral valve restore, I might take antibiotics earlier than any dental process. — Dr. Marc Gillinov

Query #21: Bridget asks, “Mitral valve restore at 60 years of age. Pig pores and skin. If my valve final 10-20 years what can I count on for my subsequent surgical procedure. Invasive. Open coronary heart. Thanks.”

It could be potential to put a brand new organic valve by way of the femoral vein–the vein in your leg. — Dr. Marc Gillinov

Query #22: Cindy asks, “Effectively and why does nobody inform you the grade? I ask like loopy attempting to know and thanks SO a lot for saying that!!!”

I need each affected person to know the whole lot about themselves, so I am going over all exams carried out, from the blood exams to the echo and CT scan, and clarify the whole lot. — Dr. Marc Gillinov

Query #23: George asks, “How does ejection fraction examine to the 1 by way of 5 scale?”

Ejection fraction is graded from 0% to 70%. It’s a measure of the left ventricle’s contractility or squeezing energy. A standard ejection fraction is 50%-55%. With a severely leaking mitral valve, a standard ejection fraction is 65%. — Dr. Marc Gillinov

Query #24: Michael asks, “What’s your opinion on the clip process for repairing the mitral valve?”

It really works properly in chosen sufferers. We’re doing an NIH-sponsored trial evaluating the clip to surgical procedure, and this can give us some good information. Proper now, within the US, the clip is accepted for mitral valve restore in sufferers who’re at very excessive or prohibitive danger or very excessive danger for surgical procedure. — Dr. Marc Gillinov

Query #25: Judy asks, “Can two mitral valve repairs be accomplished again to again or should you at all times get a valve substitute after the restore begins to fail?”

If a restore has failed, we are able to re-repair about 70%. It is dependent upon the findings at surgical procedure and the surgeon’s stage of expertise. Re-repair is the best choice when possible. — Dr. Marc Gillinov

Query #26: Bonnie asks, “Are ladies extra under-diagnosed than males with asymptomatic mitral valve prolapse? None of my primaries thought I ought to see a heart specialist, but once I lastly did she & I have been each shocked to seek out out I’ve extreme mitral valve regurgitation.”

I don’t assume that ladies are extra under-diagnosed, however it’s actually potential. I’m glad that your physician heard your murmur. It may be troublesome to listen to these murmurs with a stethoscope. You have got a great heart specialist. — Dr. Marc Gillinov

Query #27: Stephanie asks, “I’ve anterior leaflet drawback. Can that be repaired?”

Anterior leaflet prolapse is more difficult to restore than posterior leaflet prolapse. Nonetheless, skilled surgeons can restore a valve with anterior leaflet prolapse greater than 95% of the time. — Dr. Marc Gillinov

Query #28: Jo asks, “I’ve important bileaflet mitral prolapse. Can this be repaired?”

98% restore charge for bileaflet prolapse. — Dr. Marc Gillinov

Query #29: MJ asks, “Ought to any diploma of prolapse have a restore? Even when there’s simply gentle regurgitation? You talked about prolapse is one other title for myxomatous illness. So restore is indicated for this additionally? I believed you mentioned this will likely by no means progress at this low stage?”

Prolapse = Degenerative illness = Myxomatous illness. The valve ought to solely be repaired if the leak is critical, that means it’s 3 or extra on a scale from 0-4. — Dr. Marc Gillinov

Query #30: Nameless Attendee asks, “Are sufferers who’ve Vascular Ehlers Danlos (vEDS) additionally operated on for mitral valve restore versus substitute?”

Sure. — Dr. Marc Gillinov

Query #31: Dan asks, “I’m additionally a profitable and VERY grateful 2015 mitral valve restore affected person of Dr Gillinov. My query is, ‘How necessary are pre-antibiotics earlier than dental procedures after MV restore surgical procedure? Is it a critical challenge if this doesn’t occur?”

I might take antibiotics earlier than all dental procedures if I had earlier mitral valve restore. An occasional miss will normally not be important. — Dr. Marc Gillinov

Query #32: Robin asks, “How current does the CT Scan need to be?”

Inside 6 months as a screening instrument earlier than robotic mitral valve surgical procedure. — Dr. Marc Gillinov

Query #33: Eric asks, “77 12 months previous energetic male with no important comorbidities and no MAC famous. A2 flail with possible chordae rupture and gentle P2 prolapse on TEE with anterior eccentric jet and average MR. Publish gentle non-STEMI MI in 2014 with non astomosed LIMA graft. Cath demonstrates solely 30-40 coronary artery”irregularities”. TTE demonstrates LVEF 40-50%. Regular measurement LV with gentle left aspect irregularities.”

Think about surgical restore. — Dr. Marc Gillinov

Query #34: Bridget asks, “What’s the finest instrument to indicate calcium within the arteries? My cath confirmed no calcium construct up indicators however I had a coronary heart scan with a results of 80.”

Cath is the definitive check to find out the standing of the coronary arteries and the extent to which there are necessary lesions/blockages. — Dr. Marc Gillinov

Query #35: Stephanie asks, “Does Dr. Gillinov do valve restore with sternotomy or thoracotomy (ie: not utilizing the robotic)?”

Sure, we provide all approaches to the valve and select the method that’s most secure for every particular person affected person. Security is by far a very powerful consideration. — Dr. Marc Gillinov

Query #36: Eric asks, “Any motive why sternotomy with substitute trumps minithoracotomy and restore. And even sternotomy with chordae restore?”

Most necessary to restore the valve if potential. The particular chest wall method influences restoration time, however the first precedence is a secure valve restore. — Dr. Marc Gillinov

Query #37: Eric asks, “Is Mitraclip a viable method with ruptured chordae and A2 flail and gentle P2 prolapse?”

It is likely to be. It is dependent upon the very particular anatomy. — Dr. Marc Gillinov

Query #38: Michael asks, “What about substitute of mitral valve? I had substitute 10 years in the past. Are you able to do it robotically?”

Sure we are able to substitute sure mitral valves robotically. — Dr. Marc Gillinov

Query #39: Heather asks, “Are you able to communicate in any respect to what you’ll suggest for somebody who has a Cosgrove Ring and has been advisable for that ring to get replaced?”

It sounds such as you want a reoperation for a failed mitral valve restore. In most situations of reoperation, we do take away the earlier ring after which work to re-repair the valve, if possible. — Dr. Marc Gillinov

Query #40: Nameless asks, “Should you want an aortic valve reoperation and have a leaking mitral valve, I assume that it is best to have a sternotomy and repair them each on the similar time.”

Sure.– Dr. Marc Gillinov

Query #41: Ann asks, “I have Pulmonary Hypertension, attributable to congenital coronary heart failure. Had coronary heart cath final Sept and rt coronary heart numbers have been higher in November. Final echo accomplished 2 yrs in the past. Subsequent one to be accomplished in October. Pulmonary Hypertension not being handled.”

There are few particular remedies for pulmonary hypertension. Whether it is induced/worsened by a leaking mitral valve, fixing the valve may help. — Dr. Marc Gillinov

Query #42: Karen asks, “Do sufferers typically develop SVT just a few years put up mitral valve restore? Is it possible associated to the earlier surgical procedure or only a new coronary heart anomaly?”

Seemingly a brand new discovering. Atrial fibrillation can happen as we grow old. — Dr. Marc Gillinov

Query #43: Nameless asks, “I’m Dr.Gillinov’s affected person. Acquired a robotic mitral valve restore two years again for regurgitation at Cleveland Clinic. Query: 1) How lengthy do you proceed to take Metoprolol. 2) Do you need to management salt, oil and different meals consumption even after few years of surgical procedure 3) Additionally occasionally you see coronary heart charge going up or down, is it regular. Thanks!?”

Until there’s a particular indication (e.g. hypertension), there is no such thing as a have to proceed metoprolol. There isn’t a particular weight-reduction plan for the repaired valve. — Dr. Marc Gillinov

Query #44: Selene asks, “How lengthy will a tissue valve for aortic valve substitute final?”

Usually 10+ years. — Dr. Marc Gillinov

Query #45: Jim asks, “Thanks Dr. G for all that you simply do! I had Mitral Valve Restore surgical procedure just lately and sadly needed to have a cardio model to get coronary heart beating regular once more & then developed Coronary heart Block inside a month afterwards & now have a pacemaker. I’m extraordinarily grateful for a profitable restore surgical procedure, however simply wished to ask you the way widespread it’s for sufferers to want a pacemaker after Mitral Valve Restore surgical procedure & wished to get your finest guess as to why this will likely occur?”

After a mitral valve restore, roughly 1-2% of individuals will want a brand new pacemaker. It may be associated to therapy of atrial fibrillation, which may happen after coronary heart surgical procedure. — Dr. Marc Gillinov

Query #46: Christina asks, “My son Dr. Siewe is scheduled for MV robotic sx mid of subsequent month on the Cleveland clinic. I hope to see Dr. Gillinov subsequent month throughout or after the process.”

I stay up for assembly you. — Dr. Marc Gillinov

Many Thanks Dr. Marc Gillinov!

I’ve to increase a mighty “THANK YOU” to Dr. Marc Gillinov for taking the time to reply the affected person questions submitted throughout our particular webinar, “5 Warning Indicators You Might Want Coronary heart Valve Surgical procedure”.

Carry on tickin!
Adam