American correction used to repair a mitral valve

Aug 17 2007

Dr. Gerald Lawrie, a cardiothoracic surgeon with the Methodist DeBakey Heart Center, is the first to use a surgical robot to successfully repair a mitral valve using an advanced technique of repair called the "American Correction."

On Aug. 14 at The Methodist Hospital in Houston, Lawrie used the FDA-approved daVinci robot to repair the mitral valve of a 62-year-old man. Standard surgeries for this repair involve opening the chest and a subsequent long recovery for patients. With the minimally invasive technique, patients suffer fewer complications and return to their normal lives much quicker, Lawrie said.

“We have performed the American Correction for over 15 years in 1,000 patients with a great deal of success, and now we adapted the robot to our technique,” he said. “It took seven months of intense training and a major team effort to be able to perform this advanced, well documented surgery with the robot.”

Instead of opening up the chest, Lawrie made four small incisions along the right side of the chest to insert small surgical instruments attached to adjustable robotic arms. Attached to one is a camera which sends images back to a console where he operated the other surgical instruments attached to the arms.

The daVinci System's ergonomic design allows the surgeon to operate from a comfortable, seated position at the console with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands.

Also, the robot is ideal for the highly technical mitral valve repair surgery because it gives the surgeon a 3D, 10 times magnified view of the operating field, which provides an excellent view of delicate tissue and organs.

The surgery takes longer than the traditional procedure but there are more benefits for the patient.

“Because we are not opening the chest, there is less scarring, fewer wound complications, and a much quicker recovery time”, Lawrie said. “Most patients who have an open repair would not be able to drive or do things like hit a golf ball for three weeks to a month, but with this procedure they should be able to do those things a week after surgery.”

The mitral valve is the inflow valve for the left ventricle, the main pumping chamber of the heart. Blood flows from the lungs, where it picks up oxygen, across the mitral valve and into the left ventricle. A repair is conducted to treat leakage or narrowing of the mitral valve. In some cases, the mitral valve is replaced with an artificial valve. A repair is better than a replacement because it is more durable, Lawrie said. It has been proven the long-term survival rates are better, there is reduced risk of strokes, infection, and the patient is free from long-term treatment with blood thinners.

The original technique for mitral valve repair, the “French Correction” developed in the 1960's is widely used but has only a 60 percent success rate. The American Correction, developed at The Methodist Hospital, has close to 100 percent success rate and is recognized as a true breakthrough in mitral valve repair.