At only a few centimeters, the mitral valve in your heart is small in size but its job is giant — making sure that your blood flows in the right direction through your heart and body.
The valve opens and closes with each beat of your heart, sending blood through your aortic valve and out to the rest of your body.
When the mitral valve leaks, blood backs up into the heart’s left atrium and into the lungs. People who have a leaky valve can experience shortness of breath, pressure in their chest while lying down, heart palpitations and a sensation that their heart is jumping in their chest. Many people complain of vague fatigue, one that often is mistakenly attributed to growing older and slowing down, when the real culprit may be a faulty heart valve.
Dr. Jessica Yu Rove, a cardiac surgeon at UCHealth University of Colorado Hospital, is a plumber of sorts. She fixes heart valves, including mitral valves, and is one of only a few surgeons in the Rocky Mountain West to use a robot, in her case the da Vinci Xi robot, to repair a mitral valve. The minimally invasive robotic surgery limits the need to cut the breastbone and spread the two sides of the chest apart to access the heart.
“It’s a game changer for patients,’’ said Rove, who is also an associate professor of cardiothoracic surgery at the University of Colorado School of Medicine.
Why opt for robotic mitral valve repair
Patients who opt for robotic surgery for mitral valve repair spend less time in the hospital. At UCHealth University of Colorado Hospital on the Anschutz Medical Campus, patients spend an average of 3.7 days in the hospital compared to 7 days for patients who have traditional open-heart surgery. Blood transfusion rates are also lower.
The robot removes the natural jitter of even the steadiest human hands, and its steel implements enjoy agility and precision far surpassing those of human limits – particularly in tight spaces.
The surgeon’s console provides 3-D visualization while monitors around the operating room display the proceedings at 10X magnification.
After general anesthetic is given, Rove makes an incision under a patient’s right arm that is no longer than the length of a credit card. She is careful to make the incision to avoid slicing the pectoralis muscle. Three smaller 1-centimeter incisions are made above and below the main incision to allow the arms of the robot to access the heart. Another small incision in the groin area allows access to the right femoral artery and vein where the heart-lung machine is connected.
“With sternotomy or traditional heart surgery, we have to fracture the breastbone. When you consider patients who need heart surgery, our average age is 67, it’s not inconsequential to break a bone, then add open heart surgery on top of that. Excluding the sternotomy has benefits,’’ Rove said.
“The surgery itself,’’ Rove said, “is shockingly well-tolerated.’’
Robotically assisted mitral valve repair
During surgery, Rove works at a console, looks into a screen with the exquisite optics, giving her a magnified view of the mitral valve. From the console, she maneuvers instruments that are attached to the robot.
“The visualization is absolutely superior to any other minimally invasive cardiac approach,’’ she said. “I’ve done the thoracotomy approach for several years before using the robot, and the robotic visualization is superior. It is a magnified view of the heart, and then having your instruments inside the heart with almost 360-degrees of rotation in your hands bi-laterally is just incredible.’’
When a mitral valve leaks, it’s often because a leaflet, a flap that opens and closes with each heartbeat, is not working properly. A mitral valve has two leaflets, anterior and posterior, and opens and closes to allow blood to pass through and multiple chords that connect the leaflets to the left ventricle.
During surgery, Rove uses scissors attached to a robotic arm to cut out abnormal pieces of the leaflet, and she uses a suture to repair the valve leaflets. If a chord, colloquially known as the heart strings, has ruptured, she can replace it with a new chord made of goretex.
Performing her first robotic heart surgery in February 2023, Rove and her team trained for 10 months to perfect their teamwork and the robotic approach for heart surgery.
She completed a workshop with the Society of Thoracic Surgeons, and her team traveled to health systems across the nation to observe robotic cardiac surgery. The team includes Dr. Joseph Cleveland, chief of cardiothoracic surgery and heart surgeon; Meredith Stasi, physician assistant and bedside assist; Sarah Longyhore, physician assistant and bedside assist; Ronny LaMar, a registered nurse and cardiothoracic service line coordinator; and Tamara Mayne, also a registered nurse and cardiothoracic service line coordinator.
Mitral valve surgeries
They practiced the surgery using lifelike models of the mitral valve. Much of the training is focused on the technical aspects of the surgery, though communication and choreographing with the bedside operator are key to mastering the surgery.
In the operating room, the team includes an anesthesiologist, a perfusionist who runs the heart-lung machine; Rove, a bedside operator who assists the surgeon inside the chest; a scrub nurse who prepares all the tools and equipment needed for the cases, and a circulator who runs the room, talks to family and is available to provide anything that is needed.
“The bedside operator is really my partner in performing surgery, helping with very critical parts of the procedure,’’ Rove said.
The team perfected each of their roles and responsibilities.
“We were acutely aware that we could not ‘practice’ on the first patient. We needed to be ready, very ready. We did not have room for error,’’ Rove said. “For years we have sustained excellent mitral repair outcomes. It is a procedure with very low morbidity and mortality. We knew we couldn’t experiment, so that was another reason to be practicing so much with each other. We got as much training as we possibly could.’’
The robot also allows the doctor to perform concomitant procedures that sometimes accompany mitral valve disease. One of the most common pathologies accompanying mitral valve disease is atrial fibrillation (AFib), an irregular, often rapid heartbeat, that frequently causes poor blood flow. It occurs when the heart’s upper chambers beat out of coordination with the lower chambers.
Rove can also perform a Cox Maze procedure, or surgical ablation for atrial fibrillation; close the left atrial appendage, a small sac in the left atrium where blood clots may form; and close holes that are between different chambers of the heart.
How best to address mitral valve problems
Dugald Owen, a recently retired professor of philosophy at Fort Lewis College in Durango, found his way to Dr. Rove for robotic mitral valve repair surgery after he visited his cardiologist in his hometown.
“I wasn’t feeling bad, I did just fine hiking, and I couldn’t feel anything at all,’’ Owen said. “The cardiologist said it would only get worse. My heart would pump harder, and so I eventually would end up with thickened heart walls down the road, so he said it was smart to go ahead and do something about it now, before there was an injury.’’
Owen, an avid hiker who loves reading and thinking, made his way to the Anschutz Medical Campus in Aurora to talk to Rove.
“She was so good, so clear and patient and just competent in her manner and approach,’’ Owen said. “And it was hilarious, though, because she went through the long description of what she would do, and she said, and there’s one thing that I need to tell you, and if it makes you change your mind, that’s ok: ‘This would be the first time that I’m doing this.’’’
Owen didn’t change his mind and had surgery in February 2023. He still laughs when he relays the conversation with Dr. Rove.
“I thought it was funny, and it’s been a great story to tell when I talk about my surgery,’’ Owen said.
All went well. Owen’s recovery took several months, and his heart went into AFib after brief surgery, which is not uncommon, Rove said.
“I had a couple of side complications, but the surgery itself was done perfectly and never showed any problem at all,’’ Owen said. “While I was there in the hospital, I had a short spell of arrhythmia but got medication, and it went away after that. When I got back and was recovering in Durango, I had an esophageal ache or pain that made it hard to swallow food for a few days. That was the hardest part, so I had to lay off eating very much for a few days, and I have been fine since then.’’
In late August, Owen took a 19-day rafting trip on the Colorado River through the Grand Canyon. He and his friends started at Lee’s Ferry and ended at Lake Mead.
“The canyon was magnificent, as expected. What I didn’t anticipate was the exertion involved in rowing, carrying equipment up steep sand banks and hiking a dozen side canyons. Thanks to Dr. Rove, my strength and stamina held, making the trip a high point in my life,’’ Owen said.
Another patient, Michael Brown had been short of breath for about three years and had AFib.
“We were on a cruise, and I didn’t want to walk up the stairs. My wife walked up the stairs, and I was like, ‘I don’t feel like I want to,’’’ said Brown, who, in his younger years, spent many years in Steamboat Springs before moving to Newcastle, Colorado, a few years back.
Brown had done exhaustive research about robotic mitral valve repair surgery before opting for the surgery at University of Colorado Hospital. He said he was frustrated in his search, finding it difficult to find information about robotic mitral valve repair in Colorado.
In the operating room, Rove performed mitral valve repair, maze ablation and atrial appendage ligation to reduce the risk of a blood clot forming in the atrial appendage, a pouch-like extension of the left atrium.
Brown was referred to UCHealth and had a consultation with Rove, who completed the surgery in August. Brown spent five days in the hospital.
“I have to say this about her, we (Brown and his wife) talked to her every day,’’ said Brown. “Even in the ICU, she personally pulled some lines and tubes out. I said, ‘Isn’t this below your pay grade?’ And she said, ‘No, I am qualified to do this,’ and I said, ‘I wasn’t asking if you are qualified. I think a nurse should be doing this.’ She said, ‘No, I want to do it.’
“She was very attentive; she inspired a lot of confidence,’’ Brown said.
This winter, Brown says he wants to ski Snowmass this winter, without fear of having to worry about a cardiac event at 12,000 feet.
Only three weeks out from surgery, he was walking 30 minutes a day. His goal is to walk an hour a day.
“My thing is to get back to walking an hour a day and to some travel plans. … We do quite a bit of travel, and that’s what we want to do,’’ Brown said.
Over the years, he and his wife have traveled the world. The best places, he says, are Croatia and Aitutaki on the Cook Islands in the South Pacific.
At 73, Brown is happy to be out walking in the Rocky Mountains, and he is looking forward to traveling to more places, near and far.
After five days at University of Colorado Hospital, he made the four-hour drive back home, happy to have such a big surgery behind him.
“I’m happy to have found Dr. Rove, and I’m happy to get through it.’’