NewYork-Presbyterian. The University Hospital of Columbia and Cornell.

Cardiothoracic Surgery

Heart Valve Repair and Replacement

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Heart valves are flaps, or leaflets, of tissue that ensure that blood entering or leaving the heart moves in the proper direction, with no backflow. The heart and its great vessels have a total of four valves, the mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Valvular disease can affect any of these four valves, and can interfere with the normal flow of blood through the heart. Heart valves that are defective may either be repaired or replaced with a tissue or mechanical substitute, depending on the nature and severity of the condition.

Repair of Heart Valves

One method of heart valve treatment involves restoring the valve to normal function by removing damaged or malformed tissue and surgically reconstructing the valve. An advantage of this method is that the patient's own valve tissues are used, so that long-term anticoagulation is not required. NewYork-Presbyterian's heart surgeons have special expertise in mitral valve repair.

Minimally Invasive Repair of Heart Valves

For patients desiring the benefits of mitral valve repair without the trauma of conventional surgery, NewYork-Presbyterian's expert surgeons offer minimally invasive approaches to mitral valve repair. Using the most advanced technology including robotically assisted surgery the damaged mitral valve can be repaired through a small (4 inch) incision between the ribs on the right side of the chest. This approach, called a mini-thoracotomy, avoids the full breastbone incision that is required in the traditional open surgery. By using the mini-thoracotomy to access the mitral valve, we are able to lessen post-operative discomfort, minimize scarring, and reduce recovery times.

Investigational Studies

Everest II

NewYork-Presbyterian Hospital/Weill Cornell Medical Center and NewYork-Presbyterian Hospital/Columbia University Medical Center are conducting investigational studies through the Everest II Clinical Trial of a new device for repair of mitral valve leakage. By holding together parts of the leaflets that form an abnormally large opening for the mitral valve, this device helps to prevent backflow of blood from the left ventricle to the left atrium of the heart as it beats. Placement of the investigational device does not require surgery; a catheter is inserted into a peripheral blood vessel, and is guided to the heart where the device is positioned. After ensuring that the correct placement has been achieved, the catheter is removed. The patient remains under general anesthesia throughout the procedure and can return home within 48 hours. There is no surgical wound just a small adhesive strip where the catheter was placed. Patients take clopidogrel for a month and aspirin indefinitely; there is no need for a blood thinner. As with all minimally invasive procedures, this mitral valve treatment results in less pain, shorter hospital stays, and quicker recovery time.

Partner Trial

The Partner Trial is a multi-center, randomized study to determine the safety and efficacy of the Edwards SAPIEN Transcatheter Heart Valve in high risk, symptomatic patients with severe aortic stenosis. Following evaluation by a cardiologist and a cardiac surgeon patients are determined to be either surgical or non-surgical candidates. Surgical candidates are randomized to undergo either transcatheter aortic valve implantation or surgical aortic valve replacement. Non-surgical candidates are randomized to undergo either transcatheter aortic valve implantation or medical management, which may include balloon valvuloplasty. The randomization which determines study assignment is performed by a computer (like flipping a coin).

The study device is a catheter-delivered heart valve combining a balloon expandable stent and bioprosthetic valve leaflets made of bovine pericardium. Patients enrolled in the Partner Trial have clinical follow-up at 1, 6, and 12 months post- procedure and annually for 5 years.

Replacement of Heart Valves

• bioprosthetic, made from animal tissue
• mechanical, typically carbon covered with cloth
• homograft, from donated human tissue

Any of these types of valves can be inserted through the minimally invasive minithoracotomy technique described above.

In some cases, replacement of a damaged aortic valve is accomplished by using the patient's own pulmonary valve (Ross Procedure).

Last modified: 12-1-2009