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Robert Brophy, MD

Robert Brophy, MD, is a specialist in sports injuries. He says his most important achievement is the gratitude of his patients – that matters more than any plaque on the wall.

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Genetic Testing for Marfan's Syndrome

My 19-year-old son Seth was recently diagnosed with Marfan syndrome. Should my other children be evaluated? They are also tall.

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New Melanoma Treatments on the Horizon

Melanoma can spread from the changing mole on your skin to your internal organs. There are new medical and surgical treatments available for this quickly spreading cancer

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Options for Heart Valve Replacement or Repair

Dr. Ralph Damiano treats patients at

Center for Advanced Medicine
Heart and Vascular Center
4921 Parkview Place, 8th Floor, Suite A
St. Louis, MO 63110

Phone: 314-362-7260; 1-888-800-9484 Fax: 314-747-0917
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Question: I am a 68-year old male, and have been told I need surgery to replace my heart valve. What are my options?

Answer: Surgery to replace or repair heart valves is relatively common. Heart valves require surgery because they fail to either open or close completely. If they fail to open all the way, this is usually due to thickening or calcification (valvular stenosis). When the valves fail to close correctly, they become leaky (valvular regurgitation). Either valvular stenosis or regurgitation can result in congestive heart failure, and can be fatal if the valve is not repaired or replaced.

The conventional way to either repair or replace the mitral valve has been through a 12-15 inch incision in the middle of the chest and dividing the breastbone. Recently, our group and others have developed techniques to allow access to and repair of the mitral valve through a smaller (3-4 inch) incision between the ribs. This has resulted in less pain, quicker return to work, less bleeding, less scarring and less infection.

For patients with aortic valvular stenosis, the valve almost always needs to be replaced. Traditionally, this also has been done through a large incision, using the heart-lung machine. With new techniques, the valves can now be replaced through a much smaller, 3-4 inch incision, dividing only the upper third of the sternum to allow access to the valve. This has resulted in less bleeding, less time on the ventilator, and a lower infection rate, in our experience.

The newest approach for aortic stenosis is called transcatheter aortic valve replacement. A new aortic valve is mounted on a balloon catheter and is placed in the middle of the old blocked aortic valve using x-ray guidance. The balloon is then inflated, pushing the old valve out of the way, and positioning the new valve in its place. With this new approach, patients do not need to go on the heart-lung machine. Moreover, the catheter can be placed either through a very small incision in the groin or a small incision on the side of the chest.

At the present time, this is only available for patients in clinical trials, but may soon be released for patients who are not candidates for traditional surgical valve replacement We have now performed over 100 of these cases, with excellent results.

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