Mitral valve patients get robotic option that dramatically shortens recovery time

When Georgetown County Library Director Dwight McInvaill was diagnosed with a mitral valve heart problem, he half-seriously worried that a book he was writing about the Charleston painter Alice Ravenel Huger Smith might never be completed. “I was thinking, darn it, what if I die and can’t finish this thing?”

McInvaill, 62, had seen what heart trouble could do. “In my family, for generations, everybody has died young of heart disease. My grandfather died when he was 56. My dad died when he was 55.”

But he soon learned that thanks to new technology at MUSC Health, not only could his heart problem be repaired, but it could also be done without the long recovery time required in the past for such procedures. Surgeon Marc R. Katz, a recent arrival at MUSC Health, is behind the advance. 

“We’re offering a pretty exciting new service,” Katz said. “The ability to do mitral valve repairs robotically can be huge because the average length of stay for a traditional open heart surgery patient after a mitral valve procedure is over seven days. They can’t drive or lift anything for a month and no heavy lifting for three months. When we do the procedure using the robot as an assistant, the patients are going home in two days and can get back to full activities within a week or two, with really no restrictions.” 

Instead of making an incision that goes through the entire breastbone, the robotically-assisted procedure involves small incisions in the right side of the chest. “I like to describe the system as a very powerful computer interface between the surgeon and the patient. It allows us to translate our motions we use in traditional everyday surgery through tiny ports,” Katz said.

He said the daVinci Surgical System he uses gives him great accuracy. He sits in a console during the operation and uses robotic arms and other surgical instruments that are part of a cart stationed at the patient’s bedside. “The system translates my motions through those instruments,” Katz said. “We’re doing the same thing we do through open surgery, but instead of going through the breastbone, we’re just going through some muscle. That affords the shorter length of stay and the quicker recovery.”

Katz also has a scope that goes inside the patient’s heart during the procedure. “I can see the mitral valve better with this technique than I can through a traditional open approach. The scope has two cameras, so it’s true 3-D vision that’s magnified 10 to 15 times.”

McInvaill became the first patient to undergo the robotic mitral valve procedure at MUSC Health. His journey to that point began with a cough that wouldn’t go away last October. “I went to the family doctor. He put a stethoscope to my chest and found a murmur.”

McInvaill decided to head to MUSC Health to see heart specialist John Marcus Wharton. “He put me in the hospital for a long weekend,” McInvaill said. “He started me on a regimen of medications and collaborated with the surgeons in the cardiac group, and they decided they’d do a transesophageal echocardiogram on me. It revealed that I had a mitral valve problem that was causing blood to go back into my heart the wrong way. It was a prolapse of the mitral valve.”

Katz talked with McInvaill about options for treatment of his mitral valve malfunction. McInvaill wanted to move forward quickly. “He told me this was a condition that could eventually lead to heart failure, and so it had to be taken care of, and there was a way to do it that was minimally invasive. I was excited to hear about that.”

He had the procedure and woke up smiling, he said. “I was up and about in the hospital immediately.” He was able to leave the hospital in 2 1/2 days, compared to the week he’d have been there if he had traditional surgery. “I was driving within a week,” he said. “If I’d had my chest split open, it would have been a recovery of three months.”

Dr. Marc R. Katz says using a robotic system to do mitral valve repairs allows him to go through muscle instead of the breastbone, and cameras give him 3-D vision magnified 10 to 15 times during the procedure.

Katz said mitral valve repair isn’t the only procedure he can use the robot for. “There are some patients who are not eligible for repair, and I can replace the mitral valve through this same means. Other procedures we’ve done with it: repairing the tricuspid valve, closing some holes in the atrium called atrial septal defects, and we’ve taken out some masses in the heart. There’s a relatively common cardiac tumor called a myxoma. I’ve taken out many of those.”

Word is getting out about the only place to offer robotic repair for mitral valves in the Carolinas. “I’ve been doing robotic surgery a long time,” Katz said. “I had the third robot in the country. I’ve only been in Charleston since the middle of December. So although I have long experience with this, this utilization of that technology is new to this area, and it’s pretty remarkable because I’ve already got a waiting list.”

He said his techniques add to the expertise that was already available at MUSC Health. “When you blend that with the transcatheter valve experience that’s here with Dr. Daniel Steinberg — he and I are working together now — it really affords patients a tremendous opportunity,” Katz said.  

“We’re able to offer them a breadth of options they can’t get anywhere else: medical therapy, traditional open heart surgery, robotic surgery and transcatheter valve procedures. And we’re doing things especially in the last two categories that nobody else is able to currently offer. I think it’s a great opportunity for patients. It affords them options they can’t get if they go other places by experienced people who are not just learning it but have been teaching it and doing it for years.”

McInvaill is pleased with his results. He’s back at work in the library. “I thought it was a wonderful procedure,” he said. 

As for his book about Alice Ravenel Huger Smith: It may be headed to library shelves, soon. “I’ve been able to finish it.”