Q&A with Cardiovascular Surgeon Dr. Daniel O’Hair
People with mild mitral valve regurgitation often live long, full lives
and never require treatment. But once the condition becomes severe and
begins to affect your heart’s ability to pump blood, you may need
surgery to prevent serious complications such as congestive heart failure
or even death.
We recently sat down with cardiovascular surgeon
Dr. Daniel O’Hair to learn more about the dangers of severe mitral valve disease and the
latest surgical treatments, including minimally invasive
robotic-assisted mitral valve surgery.
Watch Dr. Daniel O’Hair's lecture on the "Latest Treatments for Mitral Valve Disease"
BCH: What happens when you have mitral valve regurgitation?
O’HAIR: The mitral valve sits between the two chambers — the left atrium
and left ventricle — on the left side of your heart. It has two
flaps, or leaflets.
With mitral valve regurgitation, one or both leaflets don't close tightly
and billow into the left atrium. This causes some blood to leak backward
into the atrium each time the heart squeezes. The leaky valve makes the
heart work much harder, and this can ultimately lead to heart failure.
BCH: What is the impact of this condition?
O’HAIR: Researchers have discovered that most individuals with a mild leak in
the valve are still alive five years after diagnosis. However, for those
with a severe leak that goes untreated, survival drops way off, hovering
around 60 percent surviving at five years. So, it matters how bad your
valve leaks. And, severity has a direct impact on your risk of death,
even at five years.
BCH: What are the symptoms of mitral valve disease?
O’HAIR: Signs and symptoms of mitral valve disease may include:
- Abnormal heart sound (heart murmur) heard through a stethoscope
- Shortness of breath, particularly when you have been very active or when
you lie down
- Swelling of your ankles and feet
- Irregular heartbeat
However, sometimes mitral valve regurgitation does not cause any symptoms,
even when the problem becomes severe.
BCH: Why is it important to treat severe disease – even when you
don’t have symptoms?
O’HAIR: The heart has an ability to compensate for a long period of time. Which
means your valve can leak a lot and you feel fine. So, when someone tells
you that you need heart surgery, and you feel fine, that can be a roadblock
However, if patients aren’t treated in a timely fashion, their mortality
rate is significantly higher. When we treat patients with mild or no symptoms,
when their heart is still strong, long-term survival returns to normal.
In fact, if you look at people with a severe leak in their mitral valves,
and you fast forward 10 years, 90 percent of those who choose not to have
surgery will be dead. It’s that critical.
The quicker we can stop the severe leak – even when you experience
no symptoms – the better the outcome.
BCH: How do you repair a damaged mitral valve?
O’HAIR: During surgery, we cut a segment of the mitral valve leaflet that’s
billowing and then sew the leaflet back together, allowing the valve to
close more tightly.
There are a few different ways we can perform this procedure. In the traditional
operation, which is a sternotomy, we saw through the breastbone, down
the midline, to get to the valve. A second way is called mini-mitral access,
done with an incision on the side of the body, between the ribs.
However, my preferred approach is using a robotic-assisted approach with
da Vinci robotic surgical system.
BCH: How do you perform robotic-assisted repair?
O’HAIR: With robotic-assisted surgery, I don’t have to cut any bones or
muscles, which facilitates recovery. This is done from the right side
of the chest, because access to the valve is best achieved from the right side.
Robotic-assisted surgery requires only a few small incisions for inserting
surgical equipment and a camera for viewing. Because it requires only
small incisions, patients’ hospital stays are short, roughly 2.5
days, and they can return to work within 10 days.
BCH: Can you tell us about BCH’s program for robotic-assisted mitral
O’HAIR: BCH’s Foothills Hospital is home to the
da Vinci Xi surgical system, the most advanced minimally invasive option, offering greater precision
for mitral valve repair. We started the mitral valve repair program at
BCH in February 2019, and already we’re the largest program in the
state. Patients have come to us from Colorado, Kansas, Wyoming, Florida
and even Germany for this surgery.
View slides from Dr. O’Hair’s lecture on the "Latest Treatments for Mitral Valve Disease"
To make an appointment with
Dr. Daniel O’Hair, call Boulder Heart at (303) 442-2395.