Gerald Lawrie, founding partner of Texas Surgical Associates and clinical professor at Baylor College of Medicine, has completed more than 300 consecutive mitral valve repairs during the past 15 years with record success, especially when compared to statistics for valve replacements. In doing so, he now often uses minimally invasive techniques-like keyhole surgery-that provide greater patient comfort and faster recuperation than the more traditional chest-sawing procedures.

In a recently published study of his first 200 patients, Lawrie shows that mitral valve repair significantly reduces mortality rates when compared to mitral valve replacements. Hospital mortality rates for mitral valve repair were only 1 to 3%, compared to 3 to 15% for replacements.

"Patients are benefiting from the variety of techniques which allow us to repair valves more successfully than replace them," Lawrie says. "When coupled with minimally invasive surgery, this is the way of the future for cardiovascular surgery. The exciting news is that we're already doing it routinely today in the Texas Medical Center. Patients don't have to leave Houston for this surgery."

Lawrie studied patients with a mean age of 62.5, plus or minus 14.7 years. Of the 200 patients, 103 were men, 17% previously had cardiac surgery, and 19.9% had additional cardiac procedures, such as coronary artery bypass or aortic valve replacement, performed at the same time.

There were no operative mortalities in elective, isolated mitral valve repairs and a low 30-day mortality rate of 2.5% (five patients). Patient improvement was apparent using New York Heart Association (NYHA) classifications. Postoperatively, 83.5% of patients were NYHA class I or II, compared with preoperative classifications of III or IV for 96.0% of the patients.

Seven years after the surgery, 91.3% of patients were still alive. Only 7.9% of patients needed additional operations and there was no late thromboembolism.

Success of mitral valve repair surgery is attributed to patient selection, accurate evaluation of the cause of mitral regurgitation and the surgeon's execution of the appropriate repair techniques, according to Lawrie.

In other news, TSA cardiovascular surgeons are teaching the operating room nurses at Methodist Hospital the latest techniques in minimally invasive surgery, which they recently studied in Pittsburgh.