Health News

Local cardiac surgeon leads nation in successful mitral valve repair

BRADENTON — Sarah Morrison, Richard Stephens and Clarke Williams have a life-saving experience in common.

In the past year, all three have recovered from a life-threatening heart condition called mitral valve prolapse thanks to the skill and training of Dr. Allesandro Golino, a Bradenton-based cardiac surgeon.

Golino is one of only a few sub-specialists in the country experienced in mitral valve repair, a more difficult and complex procedure than artificial valve replacement — the more traditional treatment. Golino trained at the famed Texas Heart Institute under Dr. Denton A. Cooley, the pioneer of open-heart surgery. Golino’s 96 percent success rate with mitral valve repairs is one of the highest nationwide, said Cooley, who praised his former student.

“Dr. Golino was one of our best,” said Cooley, who spoke with the Bradenton Herald by phone from his Houston office. “He is a good technical surgeon. I am not surprised he is so successful. I am very proud of Dr. Golino.”

Golino performed all three surgeries at Blake Medical Center’s Heart Institute. The benefits of repairing the leaky valve over replacing it with an artificial or animal valve are numerous, Golino said.

For Morrison, 25, repair over replacement means that she can now look forward to having children. A mechanical valve replacement would have required her to take blood thinners for the rest of her life, which would have eliminated the possibility of giving birth. While a pig’s valve offered Morrison a third option, the open-heart procedure would have put her at higher risk for complications and because of her age, would have had to be repeated within a decade of the first operation.

A thankful Morrison, a former Southeast High School health and physical education teacher, has promised Golino that when she starts a family, she will bring her children to meet the surgeon who saved her life.

Stephens, 46, had problems with two heart valves, the mitral as well as the aortic. While the aortic valve required replacement, Golino was able to repair the mitral valve, which means Stephens’ dose of blood thinners, which he must take for the rest of his life, is just half of what it would have been had both valves been replaced.

Stephens praised Golino’s skill. “Whether it is me or anyone in my family, Dr. Golino is the only doctor I would want touching me or someone I love,” said Stephens.

For Williams, who is 72, replacement meant a quicker return to a normal life and his golf game, which he jokes still hasn’t improved despite Golino’s magic touch.

“It’s a miracle,” Williams said. “I walk two miles every day. I feel good. Dr. Golino is wonderful. Maybe I am good for another 72 years.”

Unfortunately, many people who suffer from mitral valve disease never have the option of having the defective valve repaired because few surgeons have the training to do the complex and often delicate procedure, Golino says.

Moreover, many surgeons opt for replacement with an artificial valve because it is easier and quicker, a routine procedure done in every hospital that offers cardiac surgery.

For some patients whose valve is beyond repair, replacement can be a viable solution, Golino said. But the blood thinners they must take to prevent the formation of clots increase the risk of stroke and other cardiac complications.

Mitral valve repair, on the other hand, carries a higher success rate for survival, greatly reducing the need for a second operation and cutting the risk of stroke nearly in half.

So why aren’t more leaky mitral valves repaired?

Too few specialists

Too few cardiac surgeons are entering the sub-specialty and too few patients are benefitting from early intervention and treatment before the onset of symptoms, says not only Golino but also Dr. David Adams of the Mitral Valve Repair Center at The Mount Sinai Hospital in New York.

“The superiority of mitral valve repair over mitral valve replacement with a mechanical or bioprosthetic valve is now well established,” Adams says on the center’s Web site at www. mitralvalverepair.org.

“Primary care doctors are often the first ones to pick up a heart murmur or leaky valve when they listen to the heart with a stethoscope,” Golino said.

A common condition, mitral valve prolapse, is often passed down in families, affecting 2 percent to 5 percent of the population. It can affect both men and women and all ethnic groups. An estimated 100,000 people need surgery each year to either repair or replace their leaky valves, usually when they reach mid-life.

“If you do surgery on someone before symptoms occur, they have the same survival rate as the normal population,” Golino says. “But if you wait until the symptoms come, the survival rate goes down.”

Golino would like to see patients with mitral valve problems followed over time, with routine, periodic echocardiograms that can detect problems before the symptoms appear. Those symptoms include irregular heartbeat, dizziness, fatigue and shortness of breath. As the mitral valve prolapse worsens, the heart enlarges, a condition easily picked up on an echocardiogram.

The Mount Sinai Web site advises patients interested in the mitral valve repair option to consult a sub-specialist who does at least 25 procedures a year.

Golino is now performing more than 50 repairs a year with a success rate of 96 percent, which is above the national average.

Human contact

On one point, Golino is adamant — it takes a surgeon’s hands, not a surgical robot, to successfully perform the complex repair procedure. Proponents say robotic surgery lessens the risk of infection and blood loss because the robot’s arms are inserted into the body through very small incisions as opposed to the large incision necessary in open heart surgery.

“Everybody is trying to do mitral valve repair with a surgical robot, even the Cleveland clinic,” Golino says. “But the outcome data is horrible.”

Golino cites studies that show 10 percent of the patients who had surgical robotic mitral valve repair procedures had to have the operations redone within one year.

The problem, says Golino, is the robot’s hands miss what human hands can repair.

“You have one shot and you have to do it right,” says Golino. “If you leave one little bit of the mitral valve prolapse behind, it’s going to get worse, and 10 percent of what they are doing with robots is so bad it has to be done over.”

Dr. Cooley, Golino’s mentor and president emeritus of Texas Heart Institute, agrees.

“I think a more effective repair can be done with regular open-heart technique, but the younger generation of surgeons is trying to make smaller and smaller incisions. I don’t think that trend will be permanent. Smaller incisions sometimes handicap the surgeon in making a good repair.”

Golino will give a lecture on mitral valve repair at 5:30 p.m. Thursday in the Dolphin Room at Blake Medical Center. The public is invited. Call (888) 359-3552 to register.

Donna Wright, health and social services reporter, can be reached at 745-7049.

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