Surgeon Determined to Make Mitral Valve Repair the Gold Standard
Didier De Cannière, M.D., Ph.D., professor of surgery, is on a mission. A pioneer in minimally invasive robotic surgery, he joined the Miller School from one of Europe’s largest heart surgery services nearly two years ago in hopes of helping lead a revolution in mitral valve repair in the United States.
Today, most patients diagnosed with a leaking, or regurgitant, mitral valve, which controls the flow of oxygen-rich blood from the lungs to the body, undergo open-chest surgery to replace their defective valve with a bioprosthetic or mechanical valve.
But like fellow experts in his elite league, De Cannière, who is director of the new Institute for Surgical Innovation and the Minimally Invasive and Robotic Cardiac Surgery Center at University of Miami Hospital, is deeply committed to proving that repairing – rather than replacing – the mitral valve is the best option, with the best results, for nearly all patients with leaking mitral valves. Several scientific studies in prestigious medical journals, such as Circulation, have shown that in Europe, where mitral repair was developed, repair leads to longer survival rates, better heart function and fewer strokes and other complications than mitral replacement. In most cases, it also eliminates the need for long-term use of anticoagulants.
“Mitral valve repair is way superior to replacement, yet only 15 percent of cardiac surgeons repair rather than replace valves,” says De Cannière, who has shared his expertise around the world and, most recently, was chief of cardiac surgery at Erasme Academic Hospital and Tivoli University Hospital at Brussels Free University in his native Belgium. “What I know for a fact is that there is added value in these new technologies for patients and I came here to be part of the group of people who are, hopefully, going to really demonstrate this added value to their peers. This is why I am at an academic medical institution.’’
When possible, De Cannière prefers to repair leaking mitral valves with the assistance of a robotic computer that allows a minimally invasive approach, usually a few small incisions on the right side of the chest where a tiny camera and the instruments that open the pericardium surrounding the heart and stitch up the valve are inserted. Sitting at a console several feet from the patient, De Cannière guides the instruments and performs the repairs remotely while members of his team fill their vital roles. They include anesthesiologists Edward A. Maratea, Jr., M.D., assistant professor of anesthesiology, and Michael Isley, M.D., assistant professor of anesthesiology, Djohra Azzi, R.N., robotic surgery coordinator, Mario Caballero, P.A., and Andre Medina, M.D., assistant professor of surgery, who prepares the pulmonary bypass and arrests the patient’s heart during the procedure, which can last about 90 minutes.
While smaller incisions mean minimal scarring and trauma and a quicker recovery and resumption of normal activities, De Cannière notes that not every mitral valve patient is a candidate for the minimally invasive approach. Of the 35 repairs he’s performed so far at UMH, many of them repeat surgeries referred to him because of recurrences of mitral valve dysfunction, only six were robotically assisted.
“Sometimes you need to open the chest, which remains the current gold standard of heart surgery,’’ says De Cannière, who has performed more than 800 minimally invasive cardiac surgeries, including closed-chest “robotic” coronary bypasses, tricuspid repairs, myxomas resection, biventricular resynchronizations and atrial fibrillation ablations, on both the beating and arrested heart. “Why open? When the ventricle is frail, or very damaged, you want an expedited procedure and the downside of the robotic, or minimally invasive, approach is that it takes a little longer time on cardiac arrest. So I would not compromise the safety of the patient for smaller scars or a faster return to work.’’
But in almost every case, De Cannière advocates mitral valve repair over replacement and, to date, has an impressive track record in eliminating residual leakage in his mitral valve patients at UMH. As was noted in an April study in The New England Journal of Medicine, residual leakage is common, with about 20 percent of mitral repair patients still suffering moderate to severe regurgitation of blood back into the lungs after corrective surgery.
“Residual leaks are ranked 1 to 4, with grade 1 or 2 being acceptable, and we’ve got it down to zero leakage in all but one patient, who exhibits a grade 2,’’ says De Cannière, whose picture graced the cover of LIFE magazine’s issue on Medical Miracles for the Next Millennium in 1998, seven years after he completed his residency in cardiac surgery at Erasme Hospital. “So we can be very happy with these results.’’
De Cannière, who was born in Brussels, Belgium, and is fluent in French, Dutch, English and Spanish, will be even happier when he meets his goal of launching the American counterpart of the course on minimally invasive mitral valve repair that he and two other surgeons began teaching for the European Association for Cardio-Thoracic Surgery in 2004. He hopes to do it under the auspices of the Institute for Surgical Innovation and is enlisting the other top mitral valve repair experts in the U.S. to join him.
“I want UMH to be a Center of Excellence in mitral valve repair where we tailor each procedure to the individual patient,’’ De Cannière says. “But I want others, especially at UM, to be able to do the same because mitral valve repair, not replacement, should be the gold standard. There are enough patients out there. We just need more visibility.’’