MITRAL VALVE REPAIR
Heart surgeons use robot to improve outcomes
By Greg Glasgow
October 2023
Even before the robot, the University of Colorado Department of Surgery was leading the way when it comes to mitral valve surgery. Morbidity and mortality outcomes for mitral valve repair at CU are well below the national average. In 2019, CU surgeons began using a minimally invasive approach to repair leaky heart valves that affect blood flow in the body and can lead to congestive heart failure.
“Guidelines support repairing — rather than replacing — mitral valves when possible,” says Jessica Rove, MD, associate professor of cardiothoracic surgery. “We know that mitral valve repair is very successful in helping patients avoid the sequelae of severe mitral regurgitation including dilation of the heart chambers, atrial fibrillation, and heart failure.”
The minimally invasive approach involves going between the ribs on the right side of the body to operate on the heart. Surgeons don’t have to break the breastbone or any other bones, giving patients a quicker and potentially easier recovery.
ENTER THE ROBOT
Jessica Rover, MD
In 2022, Rove and Joseph Cleveland, MD, chief of cardiothoracic surgery, began looking to improve patient outcomes even more. Rove and her team traveled to several sites around the country and trained for months to gain proficiency in the technology-aided technique.
“With the robot, you can drive the camera into the heart and get a 3D, high-definition view of the valve,” she says. “It’s a level of detail that you could never get traditionally, even wearing loupes. Additionally, your robotic instruments have a greater range of motion than the human hand, and your instruments are inside the heart. You are essentially doing the procedure with your hands inside the heart.”
Rove and her team performed their first robotic procedure in February 2023 and had done 12 more as of late July. Efficiency has improved, she says, and the results have been great. The robotic procedure has also meant a reduced length of stay in the hospital after surgery — from an average of 6.8 days to 3.8.
EASIER RECOVERY
Additional advantages of minimally invasive robotic surgery, as opposed to a traditional sternotomy, include less blood transfusion, easier wound healing, and fewer restrictions after the procedure.
“If you have a sternotomy, you can’t lift more than 10 pounds for four weeks; you can’t drive a car for four weeks,” Rove says. “With the minimally invasive procedure, I had one patient who was playing tennis a month after surgery. That doesn’t happen after a sternotomy.”
One of the first patients to undergo the robotic procedure was Jeannie McNeilly, of Denver, who had a robotic mitral repair in February 2023.
“At my first appointment, I was favorably impressed by Dr. Rove as she stared at the computer screen showing my faulty mitral valve,” McNeilly says. “I could see it in her eyes that she was thinking, ‘I know what I’m going to do when I get in there.’ I could see the wheels turning.”
McNeilly had almost no pain after her procedure, and she was up and walking the same day as her surgery. She left the hospital after three days and did the rest of her recovery at home.
Jessica Rove, MD, associate professor of surgery, says that using the technology is like “doing the procedure with your hands inside the heart."
Robotic mitral valve surgery also presents a greater collaborative opportunity for the surgical team. While Rove sits behind the controls of the robot, other highly trained specialists are at the patient’s bedside, assisting and managing the robot.
“With traditional heart surgery, the surgeon controls a lot at the bedside,” says Rove, who did her surgical residency at the CU Department of Surgery and became the department’s first female attending cardiothoracic surgeon when she returned in 2018 after a fellowship at Washington University in St. Louis.
“When you expand to using the robot for cardiac surgery, you are dependent on a team of people, and everybody has to speak up,” Rove continues. “We had to feel very comfortable communicating as a team, and that changes the dynamic in the operating room. We put a lot of trust in each other. It has really elevated the game of some of the people involved in the operating room, and it’s really highlighted some of the skills of other people on our team, which has been very fulfilling to see.”