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OR-Live.Com Presents: Early Intervention in the Treatment of Mitral Valve Disease: Clinical Guidelines, Treatment Options &Amp; Patient Benefits

November 12, 2008

The Cleveland Clinic and Intuitive Surgical, Inc. will present a live webcast on OR-Live.com featuring a roundtable discussion on the treatment of asymptomatic mitral valve disease. Moderator Julie Huang, M.D., staff cardiologist in the Section of Clinical Cardiology, Department of Cardiovascular Medicine; Brian P. Griffin, MD, FACC, staff cardiologist in the Section of Cardiovascular Imaging, Department of Cardiovascular Medicine; A. Marc Gillinov, MD, staff cardiac surgeon; and Tomislav Mihaljevic, MD, staff cardiac surgeon, Department of Thoracic and Cardiovascular Surgery — all of the Cleveland Clinic Heart and Vascular Institute — will discuss mitral valve prolapse, treatment options and surgery guidelines for asymptomatic patients. Following this discussion, the panel will conduct a live question and answer session with viewers.

According to the latest guidelines from American Heart Association and American College of Cardiology, select patients qualify for early surgical intervention to treat mitral valve regurgitation. At the Cleveland Clinic, a recognized leader in treatment of valvular heart disease, surgeons are able to repair more than 99% of mitral valve prolapse using da Vinci Mitral Valve Repair, a minimally invasive, sternum-sparing procedure. The procedure is performed using the da Vinci Surgical System, the world’s only commercially available robotic platform for complex, minimally invasive surgery.

“Robotically assisted mitral valve repair is the best and least invasive treatment for the majority of patients with a leaky mitral valve,” said Dr. Mihaljevic. “Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually avoids the need for long-term use of blood thinners (anticoagulation).”

About the Condition

In patients who have mitral valve prolapse, the tissue of the mitral valve leaflets and chordae are abnormally stretchy, so that as the heart beats to circulate blood, the mitral valve bows or flops back into the left atrium. Many patients with mitral valve disease are asymptomatic (have no symptoms), even with a leak that is severe. When symptoms develop, they include shortness of breath, fatigue, loss of energy, swelling of the ankles and palpitations (extra or skipped heart beats).

Most patients diagnosed with mitral valve disease do not have any leaking (regurgitation) and do not require surgery. However, in about 10 to 15 percent of people with mitral valve prolapse, there is a substantial leak and, surgery should be considered.

Surgeons can either replace the valve with a mechanical or biological valve, or they can repair it using the patient’s own tissue. Studies demonstrate that valve repair, which is facilitated by the da Vinci System, offers patients significant potential advantages over valve replacement. These advantages include reduced risk of surgical complications,(1) a higher long-term survival rate,(2)(3)(4)(5) improved function and strength of the heart,(1) more freedom from re-operation, fewer post-surgical complications,(1) no need for life-long blood thinner medication and a shorter hospital stay.(1)

In the US alone, about 40,000 people have surgery to treat mitral valve regurgitation each year.(6) In 2006, Cleveland Clinic surgeons performed 2,127 valve procedures — 1,524 primary operations and 603 re-operations, the largest number of valve procedures in the U.S.

According to Drs. Gillinov and Mihaljevic, leaky mitral valves can be repaired rather than replaced in approximately 99% of patients, and nearly 100% of patients receive a minimally invasive procedure if mitral valve prolapse is the cause of the leak.

“When a patient requires isolated mitral valve surgery for a degenerative valve, at Cleveland Clinic we can perform the operation robotically or using other minimally invasive techniques in nearly all cases,” Dr. Gillinov said. “We offer several different minimally invasive approaches, including robotically assisted procedures, a small incision on the right chest, or a small incision in the mid-line. Expertise with several approaches enables us to determine the best procedure for each patient, optimizing results.”

About the Treatment

During traditional heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves. While this approach remains in use, today most patients with isolated valve disease can be treated with minimally invasive techniques. Minimally invasive surgery is a type of surgery performed through smaller incisions. This type of surgery reduces blood loss, trauma, and length of hospital stay. There are two types of heart valve surgery: valve repair surgery and valve replacement surgery. Valve repair allows the surgeon to fix your faulty heart valve, often without the use of artificial parts. The advantages of heart valve repair include a lower risk of infection, decreased need for life-long blood thinner medication and preserved heart muscle strength. The mitral valve is the most commonly repaired valve, but the aortic and tricuspid valves may also undergo some of these repair techniques.

About the Surgeons

A. Marc Gillinov, MD, is a staff cardiac surgeon at the Cleveland Clinic Heart and Vascular Institute and is board-certified by the American Board of Surgery and the American Board of Thoracic Surgery. He holds the Judith Dion Pyle Chair in Heart Valve Research at Cleveland Clinic. Dr. Gillinov is a recognized expert in mitral valve repair surgery and in the study and treatment of atrial fibrillation. He has particular expertise in robotic and minimally invasive mitral valve surgery. He has been instrumental in the development of new, less invasive treatment approaches for mitral valve disease and atrial fibrillation. He has delivered hundreds of invited lectures at hospitals, academic meetings and seminars in the United States and abroad.

Tomislav Mihaljevic, MD, is a staff cardiac surgeon in the Cleveland Clinic Department of Thoracic and Cardiovascular Surgery. He is certified by the American Board of Thoracic Surgery and the American Board of Surgery. Dr. Mihaljevic specializes in minimally invasive cardiac surgery, robotically assisted cardiac surgery, valve repair and replacement, image-guided surgery and heart failure and cardiac transplantation. Dr. Mihaljevic’s research has focused on minimally invasive cardiac surgery, robotically assisted cardiac surgery, real-time intraoperative functional imaging for the assessment of myocardial injury and graft patency during beating heart surgery, intracardiac imaging systems and analysis of beating heart intracardiac surgery, among other research studies. He has been invited to present his research at medical symposia and conferences worldwide.

About Cleveland Clinic Heart and Vascular Institute

Cleveland Clinic Heart and Vascular Institute is the recognized world leader in diagnosis and treatment of cardiovascular disease. Cleveland Clinic has been ranked No. 1 in the nation for cardiac care by U.S. News & World Report every year since 1995. Cleveland Clinic has also been ranked among America’s Ten Best Hospitals every year since 1990 by U.S. News & World Report.

Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multi-specialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names Cleveland Clinic as one of the national’s best hospitals in its annual “America’s Best Hospitals” survey. Approximately 1,800 full-time salaried physicians and researchers at Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2006, there were 3.1 million outpatient visits to Cleveland Clinic. Patients came for treatment from every state and from more than 80 countries. There were more than 53,000 hospital admissions to Cleveland Clinic in 2006. Cleveland Clinic’s Web site address is www.clevelandclinic.org.

About Intuitive Surgical, Inc.

Intuitive Surgical, Inc. (NASDAQ: ISRG), headquartered in Sunnyvale, California, is the global technology leader in the emerging field of robotic-assisted, minimally invasive surgery (MIS). Intuitive Surgical develops, manufactures and markets robotic technologies designed to improve clinical outcomes and help patients return more quickly to active and productive lives. The company’s mission is to extend the benefits of minimally invasive surgery to the broadest possible base of patients. More information is available at www.IntuitiveSurgical.com and www.daVinciSurgery.com. Intuitive Surgical – Taking surgical precision beyond the limits of the human hand(TM)

About the da Vinci(R) Surgical System

The da Vinci Surgical System is a sophisticated robotic platform designed to enable complex surgery using a minimally invasive approach. The da Vinci System consists of an ergonomic surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance vision system and proprietary EndoWrist(R) instruments. Powered by state-of-the-art robotic technology, the da Vinci System is designed to scale, filter and seamlessly translate the surgeon’s hand movements into more precise movements of the EndoWrist instruments. The net result is an intuitive interface with breakthrough surgical capabilities. By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. This ultimately raises the standard of care for complex surgeries, translating into numerous potential patient benefits, including less pain, a shorter recovery and quicker return to normal daily activities.

The presentation described is for general information only and is not intended to substitute for formal medical training or certification. An independent surgeon, who is not an Intuitive Surgical employee, provides procedure descriptions. Intuitive Surgical trains only on the use of its products and is not responsible for surgical credentialing or for training in surgical procedure or technique. As a result, Intuitive is not responsible for procedural content. While clinical studies support the use of the da Vinci Surgical System as an effective tool for minimally invasive surgery, individual results may vary. Intuitive(R), da Vinci(R), InSite(R) and EndoWrist(R) are registered trademarks of Intuitive Surgical, Inc.

Learn more about Mitral Valve Disease and view a preview for this program by visiting: http://www.or-live.com/daVinci/2272/index.cfm?cmpid=marketwire2272

VNR: Mitral Valve Repair

 (1) Thourani VH, Weintraub WS, Guyton RA, et al.  Outcomes and Long-Term     Survival for Patients Undergoing Mitral Valve Repair Versus     Replacement. Circulation. 2003;108:298-304 (Emory University Atlanta) (2) Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye     RL: Valve repair improves the outcome of surgery for mitral     regurgitation: a long-term study. Circulation. 1995; 91:1022-8 (3) Enriquez-Sarano M, Schaff H, Frye R. Mitral Regurgitation: What Causes     the Leakage Is Fundamental to the Outcome of Valve Repair. Circulation     2003;108:253-256.(Mayo Clinic Rochester) (4) Gillinov AM, Wierup PN, Blackstone EH, et al. Is Repair Preferable to     Replacement for Ischemic Mitral Regurgitation? J Thorac Cardiovasc     Surg 2001 Dec; 122(6):1125-41 (Cleveland Clinic) (5) Grossi E, Goldberg J, LaPietra A, et al. Ischemic mitral valve     reconstruction and replacement: Comparison of long term survival and     complications. J Thorac Cardiovasc Surg 2001 Dec; 122(6):1107-24 (NYU) (6) Intuitive Surgical-sponsored study on mitral valve repair and     replacement. Document on file. 

Video-Link Available: http://www2.marketwire.com/mw/frame_mw?attachid=871757

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