Brief Answer:
I would explain as follows:

Detailed Answer:
Hello dear XXXXXXX and Derrolynn!

Welcome on HCM!

- Regarding your concern, I would like to explain that nowadays mitral valve surgery is performed with a very low complications rate, especially in cardiac surgery centers with a great volume of yearly procedures and highly expertise level.

So, you shouldn’t worry too much about as the surgery success rate is very high!

To be more concrete, in such circumstances the operative risk (including also death) may vary from 1 individual in 1000 operated (when the individual is asymptomatic) to around 1% when the patient is symptomatic (such as in your wife case).

The above numbers are prescribed in surgical centers with high expertise.

In other cardiac surgery centers with a smaller number of yearly mitral valve surgical procedures the operative risk may range around 2%-3%.

What is more important for the mitral surgery success rate and maintenance of satisfactory results after many years, besides the level of the surgeon expertise, are the cardiac performance and remodeling conditions.

As the regurgitation fraction is at least 50% and your wife is highly symptomatic, there is no doubt on the fact she needs mitral valve surgery as the best alternative for her prognosis.

For a better judging on her preoperative heart condition, a careful cardiac ultrasound (cardiac echo) examination would be necessary. I would be happy to review here directly her echo report.

Could upload it here for a second professional opinion?

- Regarding the possible approaches on how to treat mitral valve regurgitations, I would explain that both surgical approach and percutaneous approach (MitraClip) are actually available.

But, surgical approach (mitral valve repair or replacement) are superior in offering better immediate and long term satisfactory outcomes.

There are several cardiac surgery centers with high expertise, where almost all mitral valve regurgitations are successfully repaired (thus preserving the native mitral valve).

You should discuss with your surgeon on the possibility of mitral valve repair instead of replacement, as repair offers better long term survival rate, preservation of cardiac function and geometry, lowers the risk of complications and avoid the need for anticoagulation (which is necessary after mitral valve replacement).

In highly ranked surgical center, mitral valve repair may be achieved in a great majority of patients (95%) and the success rate may remain steady up to more than 20 years.

Regarding the way of approaching the heart during surgery (median sternotomy or other approaches like lateral thoracotomy, I would explain that each specific technique is applied with a very high rate of success.

Furthermore, actually mini-invasive incision (lateral thoracotomy, median sternotomy, or robotically assisted) are performed with a quite small skin incision (2-4 inches).

So, you should relax as the thoracic incision poses no technical difficulties and may be accomplish respecting the full preferences of the patients without any important complication (pain, or aesthetic seqeluea).

The success rate remains very high (greater than 95-97%).

I encourage you to seriously consider surgical mitral valve treatment without delay, as when performed timely, it is the best alternative to offer a long and unaffected life.

If mitral valve leakage is severe (such as in your wife’s case), conservative therapy (only with drugs) doesn’t provide a stable health condition without complication occurrence for a prolonged period.

Serious adverse events may seriously endanger your wife’s life (pulmonary edema, acute heart failure, endocarditis, life-threatening arrhythmias, etc.).

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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