Revolutionary procedures in the Zan Mitrev Clinic – minimally invasive mitral valve prosthesis replacement

January 22, 2025

A complex hybrid procedure – implantation of biological valve on mitral position (valve in valve) was performed in a 74 years old patient with a severe status with disrupted kidney function, placed on a dialysis machine.

This minimally invasive method, a mitral valve prosthesis replacement, is a rarity in the world, and in the Zan Mitrev Clinic, it was performed in a 74-year-old patient. The team of cardio surgeons and interventional cardiologists has performed a successful Transcatheter mitral valve implantation procedure, without classical surgery.

“Today, we have a special case, an extremely complex procedure on an extremely difficult patient. These, seemingly impossible missions which prolong the life of the patients for years and decades are possible and more frequent in Zan Mitrev Clinic, moving the frontiers of the cardiac surgery in the world. The team of Zan Mitrev Clinic has been setting new standards in the entire field of healthcare and finding ways to help more and more patients in the last 25 years. With state-of-the-art equipment, using advanced technology, we create better quality of life opportunities for our patients and justify the true function of medicine”, emphasized Dr. Mitrev.

The mitral valve prosthesis was placed through the top of the heart in the mitral position without performing classical surgery on the patient. The difference between the classical surgery and this intervention is that there is only a small opening of the chest – 5cm on the left side to access the top of the heart and using a special catheter, the new valve is placed in the existing one without using extracorporeal circulation.

“These cardiac surgery achievements indicate the great potential of the Macedonia’s healthcare. The innovative method, minimally invasive, is primarily safe for the patient, and it also accelerates the recovery of the patient and reduces the hospital stay. This procedure is enabled by the Health Insurance Fund and its package for the most elderly patients that includes this type of intervention and an increase of the number of these procedures in 2025, support for new procedures/interventions as well as complementarity of the public and private sector”, emphasized Sasho Klekovski, Director of the Health Insurance Fund of Macedonia.

The tram of cardiac surgeons and interventional cardiologists led by Dr. Mitrev, together with Doc. Dr. Oliver Bushljetikj, internal medicine specialist, subspecialist in cardiology and Dr. Vilma Ampova Sokolov, internal medicine specialist, subspecialist in cardiology.

“The patient has had two previous surgeries and needed to be operated for a third time since the prosthesis of the mitral valve has completely failed. We managed to place a mitral valve prosthesis through the top of the heart, in the mitral position without performing a classical surgery on the patent and without any additional risk of surgery she would not otherwise have survived. This type of surgery is relatively new in aortic valve replacement, and in the case of mitral prosthesis it is extremely rare. Usually, this procedure is used for the aortic valve, very rarely for the mitral valve. For this patient, whose chest has been opened in two previous occasions, that was the only option to save her life. This was the only chance for positive outcome for the patient.”, emphasized Dr. Bushljetikj.

The patient had her first operation in 1994 at VMA in Belgrade, and the second one in 2011 at Zan Mitrev Clinic when a surgery was performed to replace the mitral valve with a biological prosthesis. With the two previous surgeries, first when she was 43 in Belgrade, the second one after 17 years (2011) and now after 14 years, the patient’s life was prolonged by 30 years which is a proof of the doctors’ struggle and relevant application of the modern medicine in order to save and prolong the life.