Dr. Mario Castillo-Sang is a Cardiac Surgeon and Surgical Director of Mitral Valve and Heart Failure Therapies at the Florence Wormald Heart & Vascular Institute at St. Elizabeth. He sees patients in Edgewood.
Q: What does a mitral valve specialist do?
A: Both medical and surgical mitral valve specialists treat patients with mitral valve disease. The medical providers are interventional cardiologists who perform structural heart procedures. However, the predominant treatment for the mitral valve is surgery and at St. Elizabeth this is performed almost always minimally invasive through a 1.5-inch incision on the right chest. Patients come to us when their doctor orders an echocardiogram after hearing a murmur. A murmur indicates they have one of two issues— regurgitation (leakage) or stenosis (tightness). To treat these problems, we provide a full range of minimally invasive surgical procedures for repairing or replacing the mitral valve.
Q: Do patients need a referral from their primary care provider to see a mitral valve specialist or can they self-refer?
A: Most of our patients follow the traditional route, receiving referrals from primary care providers or cardiologists who have already identified their murmur and confirmed valve issues through an echocardiogram. However, I’ve encountered cases where patients I’ve treated inquire about family members. In such situations, we collaborate with a cardiologist who conducts necessary diagnostic studies to assess the disease type and severity. Once we have a clear understanding, we develop a tailored plan, determining whether a repair or replacement is necessary.
We do our best to accommodate patients and see them as quickly as possible, even outside our regular clinic days.
Q: What’s something surprising about mitral valve disease that people might not know?
A: With mitral valve disease, by the time one exhibits noticeable symptoms, such as shortness of breath or fatigue, their heart has likely undergone negative changes due to the valve disease. These changes can include enlargement of the top or bottom of the heart as well as a reduction in the heart’s ability to contract effectively. The patient may also have atrial fibrillation — an irregular, fast heartbeat. Unfortunately, none of these conditions are favorable, indicating that over time, the heart deteriorates. So, when someone with a murmur is constantly short of breath or fatigued, it’s likely that they have already suffered significant changes to their heart.
Q: What is St. Elizabeth doing in this field that is innovative, unique or leading edge?
A: We provide comprehensive care for managing heart conditions, with a specific focus on mitral valve disease. While nearly every hospital is equipped to perform a traditional surgery known as sternotomy, which involves cutting through the breastbone to access and work on the heart (including mitral valve replacement if necessary), fewer hospitals offer minimally invasive surgical options for mitral valve disease. St. Elizabeth is at the forefront of performing endoscopic mitral valve surgery using a minimally invasive endoscopic approach. Our technique involves creating a 1.5-inch incision and utilizing a tiny camera to guide the repair or replacement of the mitral valve, as well as to address issues with other valves, whether isolated or in combination.
While this procedure is considered open heart surgery, it is significantly less invasive eliminating the need for breastbone incisions. Patients experience minimal trauma, and by later in the day, they are sitting up in a chair. In some cases, they even begin walking around. We routinely conduct an echocardiogram to ensure that everything appears satisfactory, and by the third day, our patients generally go home.
St. Elizabeth also provides a unique procedure that is not available elsewhere in Ohio, Kentucky, or Indiana. We offer a multivalve procedure to address the mitral, tricuspid, and aortic valves using an endoscopic approach. Remarkably, we are one of only three centers in the country offering this minimally invasive, endoscopic triple-valve surgery.
We are currently in the final stages of formalizing and launching the Advanced Valve Center of Excellence, with plans to open this spring. The reason behind this initiative is that valve care is rarely isolated to one aspect of healthcare. It’s rare that valve care is exclusively provided by a surgeon or a cardiologist. Instead, we bring together the expertise of both cardiologists and surgeons to discuss the best approach. It’s important because patients and disease processes are complex often involving Âmulti-valve problems and coronary disease.
By bringing experts together, we shorten a patient’s hospital stay and get patients back to work and life faster, which makes a big difference. The new Advanced Valve Center of Excellence will allow patients to receive complete care for their valve disease without traveling far or seeing multiple providers in different locations.
Q: What is currently on the horizon for your specialty? What advances might we expect in the next few years?
A: Managing patients with mitral valve disease will remain predominantly surgical for the foreseeable 10 years. As we’ve learned more about the disease, we recognize that mitral valve repair is the best long-term approach for individuals with primary mitral valve disease (floppy or prolapsing valves). In fact, it’s the single intervention that significantly contributes to prolong life expectancy.
As mentioned, we have successfully shifted from traditional sternotomy to a minimally invasive approach. We continue to focus on improving patient recovery so they can return to home faster. Our goal is to get patients discharge to home two days after surgery. Future advancements will center on enhancing post-surgery care.
Roughly 70% of the time, our patients go home without requiring narcotics — that’s significant given the potential risks for opioid abuse. Interesting, those who go home with narcotics frequently tell me they stopped taking the medication within a week after surgery or that they never took it at all. This indicates that the post-surgery pain is minimal enough that it can be managed by using over-the-counter Tylenol or ibuprofen.
Patients typically have follow-up appointments within a week or two after surgery, and then again at three months. Interestingly, about 40% of patients express a desire to return to work, and they generally experience positive outcomes. This approach significantly contributes to our efforts in improving overall patient outcomes.
Q: Does St. Elizabeth provide screenings or methods for early detection of mitral valve disease?
A: We’re one of the few centers in the country using artificial intelligence (AI) to create a safety net. In our center, we perform thousands of echocardiograms each year for patients with valve disease. Many of these imaging tests aren’t necessarily done for valvular disease — the problem is just identified in an echocardiogram that’s done for another reason.
Over the past year, we’ve implemented software to identify patients with significant valvular disease. This prompts early conversations with both the patients and their physicians. The program aims to treat severe valvular disease before any heart damage occurs. We no longer have to wait until they’re admitted to the hospital with advanced heart failure. This initiative aligns with one of the goals of our Valve Center: reducing admissions for patients with advanced disease by identifying them earlier in their disease progression. This proactive approach has the potential to enhance a patient’s life expectancy and overall quality of life.
Q: What should patients know about the possibility of preventing mitral valve disease?
A: Most mitral valve disease is non-preventable. There’s no actual intervention for it; however, early detection is possible. I advise patients to pay close attention to any heart murmurs they’ve been informed about, whether those murmurs were detected during childhood or in adulthood. A murmur can often indicate a more significant underlying issue, which might vary in severity but should not be ignored. If a patient with a heart murmur hasn’t had a checkup in a long time, they should ask their doctor to assess the current severity of their condition especially if they are feeling fatigued or short of breath. It’s important for patients to take an active role in understanding and managing their health.
Learn more about valve disease and the heart and vascular services offered by St. Elizabeth Healthcare.
