This case involves a patient who underwent a minimally invasive heart valve surgery. The operation left the patient with holes throughout his heart, necessitating emergency heart surgery. The patient had suffered from a heart murmur believed to be linked to a valve defect for several years prior to undergoing surgery. Following the surgery, the patient experienced ongoing cardiovascular symptoms and was seen by another cardiologist. Cardiovascular imaging taken during this visit showed blood flowing into every chamber of his heart. The patient then underwent corrective surgery to repair the injury, during which the surgeon noted that the patient’s injuries had most likely been caused by poor technique on the part of his original surgeon. It was alleged that the defendant should never have utilized minimally invasive heart valve surgery technique on patient’s heart, but rather should have performed a traditional through the chest operation.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one in this case?
- 2. In general, when should the minimally invasive heart valve surgery technique be used?
- 3. Does it commonly present double heart valve problems?
- 4. Do you believe it is possible that a traditional through the chest operation should have been performed?
Expert Witness Response E-021215
I am an adult cardiac surgeon who treats all aspects of cardiac surgery including coronary artery disease, valvular heart disease, heart failure, heart transplants and ventricular assist devices. A minimally invasive approach to valve surgery is a technique dictated by the comfort of the surgeon. It is often used in individuals who have had prior chest surgery and for whom chest re-entry might be more challenging. It is often used for those who want to avoid the scar of a sternotomy or for those who believe that post-operative pain will be minimized by the smaller incision. A right thoracotomy approach is a reasonable way to address either the mitral or tricuspid valves, or both valves, in experienced hands. I prefer sternotomy due to my experience and my belief that it affords me greater versatility should issues arise. However, in experienced hands, the literature supports the use of either approach.
Expert Witness Response E-010762
I do not routinely do minimally invasive cardiac surgery, but I am very familiar with the multiple appropriate techniques for this procedure. Minimally invasive heart valve surgery is an acceptable technique with isolated single valvular disease and I am an experienced surgeon in doing this technique. I am not familiar with double valve operations being done using the minimally invasive technique. I would have to review the specific intraoperative records for this case, but in general the open chest technique would likely have resulted in better exposure for a double valve procedure.