Dr. James Gammie talks about the multidisciplinary, disease-centric mitral valve program at Johns Hopkins, including the novel therapies available to patients with structural heart disease and who often need complex care. He also addresses when to refer a patient, when repair is preferred over replacement, and how the program is focused on whole heart repair.
Yeah. Mm. Uh Hopkins has a I think an exemplary mitral valve program and that it's a multidisciplinary disease centric program uh and our structural heart program is made up of uh my colleagues who are just terrific at many aspects of diagnosis and mitral valve disease as well as treatment. And I think that uh in uh in the in the current era that a patient with with complex mitral valve disease or complex multi valve disease is best served in a Center of Excellence, a structural heart center of excellence where we can look at them from a lot of different angles and come up with the very best possible treatment plan. And so I think it's this notion that having a team, a heart team approach really affords your patient the most options and and the best likelihood of a great outcome. Mm. Yeah. Yeah. I think there's been a change over time and a understanding that it's reasonable to refer a patient early on in the disease process. And I think the cardiology community has done a terrific job about disseminating that knowledge. And what we know is that if we get that patient, if we get your patient while the ejection fraction is still above 60% while they haven't gone into a fib they haven't gotten a dilated ventricle, then we know that their outcome five years after mitral valve surgery is going to be better. Mhm. Yeah. So I was talking about earlier for degenerative mitral valve disease. So for elongated or ruptured cords degenerative mitral valve disease that the standards should be a repair rate. Well in excess of 95% you should have a rare repair replacement situation there. Um And so those types of patients, we we we uh feel that we can repair almost all of the time and that affords a lot of benefits to the patient where replacement is required is a little bit nuanced. Our experience with treating rheumatic disease and and others and published experience is generally that if you have rheumatic disease that's fairly advanced and you've got significant fibrosis and scarring of those leaflets that that patients going to wind up requiring a replacement when patients have endocarditis. That is an ideal uh disease process to be treated in a multidisciplinary center like Hopkins where we can involve are infectious disease. Docs are cardiologist and come up with a plan and our experience, we've published on this, we can fix about half of infected valves. So some of those valves, we're not going to be able to fix. And then finally we see a lot of these days a lot more patients with severe mitral annular calcification and in those cases we almost always need to do a replacement. I always say that a good mitral valve repair surgeon knows when to replace the valve. We're particularly excited Hopkins to offer a number of novel therapies for structural heart disease. And these patients as as you all know, are are complicated and they have not just uh mitral regurgitation. Oftentimes they have concomitant, try custard regurgitation, they will have atrial fibrillation. And I think from a surgical standpoint we can offer a whole heart repair, we can repair the mitral valve, we can fix the troika spit valve. We are huge fans of surgical a fibrillation, the cox maze procedure. And we've published on that and your patient, if they have a fib and they get a maze procedure, there's probably a two thirds chance that we can get them in sinus rhythm for the long term. In addition, we manage the left atrial appendage and that's been shown in just recent data have really supported that that that prevents strokes in the long term. So that's uh an exciting uh exciting aspect of of what we can we can do and partner with you for your patients. In addition, we have a number of Research trials that are ongoing or that in the process of standing up right now. In addition, we've developed a novel repair operation for secondary or functional mitral regurgitation and in fact, we're the only center in the world that does that and we've now done over 20 patients and we're really excited about this approach. This has kind of been a holy grail for our field and that we don't until now. We have not had a really good repair operation for patients with secondary mitral regurgitation. Okay, yeah