Bloodless Mitral Valve Surgery

Bloodless Mitral Valve Surgery

Mitral valve regurgitation is present when the valve does not close completely, causing blood to leak back into the left atrium.The most common diseases that cause degenerative mitral valve disease are Barlow’s disease and fibroelastic deficiency.

Bloodless Heart Valve Surgery

The most common leaflet dysfunction in degenerative valve disease is excess motion of the margin of the leaflet in relation to the annular plane. The lesions in degenerative valve disease that result in this dysfunction are usually chordae elongation or rupture. Annular dilatation is almost always an associated finding.

Advantages of Mitral Valve Repair: Why Repair Is Better Than Replacement
Mitral valve repair is the best option for nearly all patients with a leaking (regurgitant) mitral valve. Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually eliminates the need for long-term use of blood thinners (anticoagulants). For these reasons, we are committed to mitral valve repair, whenever possible.

Problems with the posterior leaflet are generally corrected by a small resection of the abnormal portion of the valve. Anterior leaflet dysfunction is managed by creation of new chords or chordal transfer. Anterior leaflet repair techniques are technically challenging, requiring a skilled and experienced surgical team to achieve the best result. All repairs include an annuloplasty, which is a complete or partial ring placed around the circumference (rim) of the valve.

In patients with mitral valve prolapse, our success rate in avoiding mitral valve replacement approaches 100%. The operations are performed with full sternotomy or minimally invasively, ensuring rapid recovery.


Bloodless Cardiac Surgery or Bloodless Heart Surgery is transfusion free cardiac surgery, where the patient’s wishes are respected based not only on religious beliefs but also with the intention of trying to avoid the potential risks associated with blood transfusions, such as infections, complications and mortality.
Any type of heart surgery can be performed without external blood, including complex operations, and this depends solely upon the patient’s state of health, which is evaluated prior to surgery in order to determine if surgery can take place.

If necessary, treatment to address the patient’s health are carried out in order to be able to perform this type of surgery.

Under the direction of Dr. Ruyra, an expert Cardiac Surgeon, our bloodless cardiac surgery team has become an international benchmark, treating patients from all over the world. Mortality under Dr. Ruyra’s expert hands in bloodless cardiac surgery is 1.5% versus mortality of 11.8% overall in Europe, reported by The European System for Cardiac Operative Risk Evaluation (

This shows that we provide first class results of the highest quality.

Why Bloodless Medicine and Surgery?

Bloodless medicine and surgery is possible, even in specialties such as cardiac surgery, which are potentially very bloody. Issues to consider regarding blood transfusions:

  • Blood is a scarce commodity. There is more demand than supply.
  • Blood transfusions are a therapeutic procedure that is not exempt from complications.
  • The use of hemoderivatives has a high cost.
  • Additionally there are many countries where the blood used is not safe.

The transfusion must always be viewed with caution because it involves a number of general risks:

  • Infection. Although blood is very safe in developed countries, there is always danger of infection.
  • Lung problems.
  • Idiosyncratic reactions.
  • May cause immunomodulation. It produces a metabolic and immunological overexertion.
  • It can reduce immunocompetence. Reducing the body’s immune system i.e. the defense capacity of our body which in turn can:
    • Activate viral infection
    • Increase postoperative infections
    • Cause cancer recurrences

There is sufficient evidence and studies which show that the results are better in patients who have undergone heart surgery if they have not needed hemoderivatives.

The latest guidelines of the Associations of Thoracic Surgeons and Specialist Anesthetists in Cardiac Surgery make it clear that we must try not to transfuse patients who undergo heart surgery. It has been recognized that a patient who has received a transfusion has a shorter life span, and even long-term survival is directly related to the number of concentrates the patient receives. In every case, this patient has greater morbidity: renal failure, prolonged intubation, major infections, cardiac morbidity, low cardiac output, neurological morbidity.

There is astounding and universal evidence to show that a patient who receives a transfusion in cardiac surgery is more likely to have higher mortality in the short, medium and long term than someone who does not undergo a transfusion, and there is even a study that claims it can affect the patient’s life in the long term.

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