Doctors Combine 2 Heart Procedures for Positive Results

Doctors repair mitral valve and AFib in single surgery

Hand holding artificial human heart model

The mitral valve in your heart helps to keep your blood moving in the right direction. In some cases, the mitral valve becomes leaky or narrowed and surgery is necessary.

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Many people in need of mitral valve surgery also have an irregular heartbeat, and a procedure called ablation is often used to correct it. Atrial fibrillation or AFib affects nearly 3 million Americans.

In the largest study of its kind, researchers find both issues can be addressed successfully during the same surgery.

“If you have a patient who is having mitral valve surgery who also has atrial fibrillation, you are more likely to achieve heart-rhythm control by doing an ablation at the time of the mitral valve surgery,” heart surgeon A. Marc Gillinov, MD says.

Leaky valves

One to two percent of the population is affected by mitral valve prolapse, a type of valve disease that causes the two mitral valve flaps to flop back and forth as the heart beats. This causes some blood to flow backward through the valve.

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Patients with a leaky mitral valve often experience symptoms of congestive heart failure including shortness of breath, leg swelling, lightheadedness, heart palpitations or fatigue. Some patients experience no symptoms at all.

When mitral valve leaks become severe, a mitral valve repair is a solution for most patients. Innovative, non-invasive techniques are available in some cases. Mitral valve surgery allows patients to experience a longer life, improved lifestyle, and better overall heart function.

Thirty to 50 percent of people who have to have the surgery though, also have AFib, Dr. Gillinov says.

Ablation for irregular heartbeats

Dr. Gillinov and members of the NIH-supported Cardiothoracic Surgical Trials Network studied 260 heart surgery patients. Half of them received mitral valve surgery alone. The other half also received surgical ablation, which is a procedure done to correct an irregular heartbeat. Ablation interrupts an abnormal heart rhythm so that electrical impulses can no longer travel through the heart.

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Results show 63 percent of the people who had both ablation and mitral valve surgery at the same time did not have an irregular heartbeat at six and 12 months after surgery compared to 29 percent of people who received mitral valve surgery alone.

“We see a lot of heart surgery patients and surgical practice across the country varies widely,” Dr. Gillinov says. “Now we have quality evidence that doing both procedures at the same time is beneficial.

The study shows combining the two procedures appears to be safe, effective, and provides people with a better quality of life after surgery. Future research may determine this as a standard form of treatment for patients.

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