Barton Fendelman has never been one to give up on a goal. So when the New York City firefighter, now 52 and retired, came to see Didier F. Loulmet, MD, NYU Langone Health’s director of robotic cardiac surgery and professor of cardiothoracic surgery, he mentioned his plan to climb Mount Kilimanjaro, the highest peak in Africa, in 2 months.
Dr. Loulmet was, to say the least, surprised. Fendelman, referred by NYU Langone cardiologist Manuel Morlote, MD, had been diagnosed with mitral valve regurgitation, a condition in which the valve fails to close, causing some blood to flow backward into the heart’s upper chamber. In severe cases like Fendelman’s, it can lead to congestive heart failure. Without surgery, Fendelman was at risk for heart failure, but he was determined and, perhaps, in denial. “I asked, ‘Can this wait until after my trip?’ ” he recalls.
It couldn’t, but Dr. Loulmet, a pioneer in robotically assisted mitral valve repair surgery, didn’t rule out his patient’s summit quest. Though he has performed the repair using open and minimally invasive techniques, Dr. Loulmet favors the robotic approach because it is the most precise and least invasive, resulting in a shorter hospital stay and quicker recovery period. “The visualization system gives the surgeon 10 times greater magnification and a 3D view,” says Dr. Loulmet. The tiny instruments, inserted through five pencil-size incisions on the right side of the heart, endow the surgeon with a greater range of motion and finer dexterity.
The robotic system requires a seasoned hand at the helm, and Dr. Loulmet has experience few other surgeons can match. He assisted Alain Carpentier, MD, on the world’s first robotic mitral valve repair in 1998 in Paris, and during the past 12 years, he and fellow cardiothoracic surgeon Eugene A. Grossi, MD, who operates together with Dr. Loulmet, have completed nearly 1,000 robotic mitral valve repairs at NYU Langone, with a success rate of nearly 100 percent. The Robotic Cardiac Surgery Program team has been chosen by the Society of Thoracic Surgeons to train other experienced cardiac surgeons in robotic mitral valve repair.
“Dr. Loulmet sets the standard for the elite top-tier surgeons internationally who are able to do complex valve repairs with this advanced approach,” says Aubrey C. Galloway, MD, chair of the Department of Cardiothoracic Surgery at NYU Langone and director of the Mitral Valve Repair Program.
Mitral valve regurgitation is the most common form of valve disease. It often results from simple wear and tear. Although some cases can be controlled with medication, the only effective treatment for severe forms like Fendelman’s is to repair or replace the errant valve. Two-thirds of surgical candidates for this condition are men, and a majority are in their 50s or 60s, though Dr. Loulmet has done surgical repairs on patients as young as 18 and as old as 89. “Health is the biggest factor, not age,” says Dr. Loulmet, explaining that some patients are too sick to endure an open procedure that requires surgeons to stop the heart and use a heart–lung bypass machine. Overall, less than 5 percent of patients receiving robotic mitral valve repair will develop recurrent mitral valve regurgitation over a period of 20 years.
Fendelman’s 3.5-hour procedure was straightforward. Seated at the console and guided by the high-definition binocular display, Dr. Loulmet made an incision in the left atrium to reach the mitral valve, removed the damaged portion of the leaflet, and repaired the valve with the remaining tissue. Finally, he implanted a device around the mitral valve, known as an annuloplasty band, to correct and reinforce the valve’s shape.
Fendelman was discharged two days later, feeling sore but otherwise symptom-free. He progressed quickly, and at his follow-up visit, Dr. Loulmet cautiously cleared him for the climb.
One month after his surgery, Fendelman departed for Tanzania, where he met up with his tour group for the week-long expedition. The final leg to the 19,341-foot summit was a challenge but, he says, well worth it. “It was a beautiful, cloudless day,” he says. “Being that high with nothing else around me was unforgettable.”
The vast majority of the 150-plus patients Dr. Loulmet operates on robotically each year are simply happy to return to good health. Still, Fendelman’s dramatic example points to the benefits of the technique. “To climb Kilimanjaro so soon after conventional surgery would’ve been impossible,” says Dr. Loulmet. “Robotic repair lets you recover quickly and move on with your life.”