​A New Pathway In Mitral Valve Heart Surgery

Improved control for surgeons, Better surgery outcomes for patients

PULSE Issue 42 | February 2024

Commonly known as “leaking heart valve”, mitral valve regurgitation is the most common form of heart valve disease where patients experience a backward leaking of blood in their heart, which can result in complications over time, such as atrial fibrillation and heart failure. 

While it is better for mitral valves to be repaired rather than replaced to avoid possible complications such as infection or clotting, traditional techniques used in current valve repair surgeries require substantial experience on the surgeon’s part to decide on the positioning, length, and the number of cords required during the procedure. This means an increased level of technical complexity and a steeper learning curve for less experienced surgeons, and may result in varying surgical results for patients. 

Driven to deliver more intuitive techniques and consistent patient outcomes, Prof Theodoros Kofidis, Head and Senior Consultant, Department of Cardiac, Thoracic and Vascular Surgery (CTVS), NUHCS, has crafted a new set of 12 mitral valve techniques improving on current established procedures, with inspiration from Roman architecture. Termed “The Singapore Correction”, the techniques allow for better surgical control through simplifying current procedures, to achieve more uniformity in patient results each time. 

In the world of cardiac surgery where precision is paramount, equipping surgeons with greater confidence in the operative procedure helps to unlock the possibility of salvaging the use of the heart’s original mitral valve rather than replacing it. To this end, the “Roman Arch” technique enables the surgeon to position the suture by using the heart’s own papillary muscle tips as a guide, which reduces the risk of surgical errors. Like a sturdy bridge connecting the damaged valve to both papillary muscles, the “Roman Arch” allows the valve repair to be done using just a single running suture. This not only simplifies the procedure for the surgeon, but also reduces the risk of complications for patients.

"The new surgical techniques for mitral valve repair allow for more standardised outcomes in patients…so more (patients) get to keep their valves, rather than have them replaced and live with the risk of related complications."

Prof Theodoros Kofidis, Head and Senior Consultant, Department of Cardiac, Thoracic and Vascular Surgery (CTVS), NUHCS

Applied by the Department of CTVS at NUHCS, the techniques have since been used in the surgeries of 10 patients with good outcomes, and have been adopted by international hospitals such as those in Italy and Greece. Enhancing patient safety and potentially life-changing outcomes in cardiac surgery set-ups, this innovation unlocks a new chapter in mitral valve treatment – one of the most common heart surgeries performed today.