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Minimally Invasive Mitral Valve Repair Surgery Gives Man His Life Back


Greg Denning has never really liked going to the doctor, and for most of his life he's been an active person who was able to avoid significant medical care.

That started to change one day when he and his wife Deb were living in Wyoming. He was building a cabin and experienced some physical symptoms, like shortness of breath and fatigue, that made Deb worry. She was concerned enough that she convinced him to go to the emergency room. They didn't find anything at the time, but after moving to Grand Junction, Colorado a short time later, Greg's symptoms got worse. He started experiencing night sweats, severe shortness of breath, and very low energy. As a high-energy couple, Greg and Deb felt frustrated to have these symptoms slowing him down.

Then, during a routine physical, Greg's primary care doctor in Grand Junction noticed signs of a heart problem and immediately sent him to a cardiologist. He was eventually diagnosed with a severe mitral valve leak that would require heart surgery.

The mitral valve separates the heart from the lungs. It opens and closes like a saloon door, according to Dr. Craig Selzman, chief of the Division of Cardiothoracic Surgery at University of Utah Health. When it's working properly, the doors swing open and small cords attached to the heart muscle pull it back into place to seal it off and prevent blood from flowing back into the lungs.

"The mitral valve is attached by these small 'parachute cords' so it will open and stop instead of swinging too far," Dr. Selzman said. "Mr. Denning had a very classic situation where some of his cords were broken. When someone has symptoms from that, the only way to repair it is surgically."

Greg's insurance wanted to send him to the hospital in Grand Junction for the procedure, but surgeons there would have to go in through the chest cavity to access his heart, breaking his breastbone in the process. The recovery would be difficult, painful, and long.

Deb, with a background as a case manager and advocate, started researching other options and discovered a minimally invasive procedure where a surgeon could go in through a small incision between the ribs and use special tools to access and repair Greg's heart valve.

Unfortunately, no surgeons in Grand Junction could perform this procedure. The only place she could find initially was the Mayo Clinic, but Greg's insurance would not approve the travel to Minnesota. She searched for a similar option closer to home and discovered that Dr. Selzman at University of Utah Hospital performed this procedure—and that Greg's insurance would approve it.

To reduce travel back and forth prior to the surgery, Dr. Selzman coordinated with doctors in Grand Junction for all the workups. When Greg and Deb arrived in Salt Lake City, they discussed the options for surgery. While many surgeons would simply replace a broken valve with a new mechanical or biological device, Dr. Selzman tries a number of different approaches to preserve the patient's own native valve. Dr. Selzman told the Dennings that he would try to repair Greg's native mitral valve three times during surgery. After that, if he felt unsatisfied with the quality of the repair, he would replace the valve.

"It really impressed us that he cared so deeply about his work that he was willing to go the extra mile," Deb said. "I feel very emotional talking about it—it was very powerful for me. I could lose this person I love, and I had this doctor working on him who I felt like I had total trust in."

Deb didn't have any family or friends with her for the duration of the three- to four-hour procedure, but she wasn't on her own.

"There was someone from Dr. Selzman's team available for me to consult along the way any time I had a question," Deb said. "I didn't feel alone because of the wraparound services that the hospital and [Dr. Selzman's] team provided. It was pretty amazing, honestly."

Greg was discharged two days before Christmas, and he says his recovery was pretty easy. He was never bedridden, he could shower and do most daily tasks on his own, and within six weeks he returned to work with no restrictions.

"I only took pain medication for about a week or two after the procedure," Greg said. "They collapsed a lung, but that was really the only major thing. A friend of mine who just went in for [heart] surgery is going to be out for three months. I talked to him yesterday and he still has chest pain. They broke his sternum. I'm glad Debbie had the drive to [find out about] the other option."

The procedure is not new, but outside of major cities or large hospital systems, many surgeons have been slow to adopt minimally invasive mitral valve repair or replacement. Dr. Selzman and his colleagues receive referrals for diseases and conditions that other specialists cannot treat. He specializes in minimally invasive cardiovascular procedures, and over many years in practice he has learned how to identify good candidates for a minimally invasive procedure, versus those who need a more traditional approach.

"Within our region, there are not a whole lot of people doing minimally invasive mitral valve repair or replacement surgery on a routine basis," Dr. Selzman said. "You have some that do them occasionally, but not as comprehensive as what we're doing [at University of Utah Health]. People look to us because we're the only academic medical center in the Mountain West."

While not every patient is a candidate for minimally invasive mitral valve repair surgery, it is a good option for many people. Older patients, especially those who are frail and might struggle to recover from an invasive procedure, can often heal much quicker. After the traditional surgery, the patient's breastbone is wired shut as it heals, so it comes with a lot of restrictions. Patients cannot drive or lift anything for six weeks, and even raising your arms to get something out of a cabinet or trying to use your arms to balance or get out of bed in the morning can set back recovery.

For Deb, finding Dr. Selzman to perform Greg's surgery was nothing short of a miracle. "It makes me want to cry, honestly," she said. "It was remarkable. We are extremely independent people; we have very active lifestyles. Because of Dr. Selzman, our lives have gone back to normal and we have a lot of years ahead of us."