Your Specialist Report — Leaky mitral valve (mitral valve prolapse with severe regurgitation)

Package: Before your surgery · Prepared for: R.T., age 62 (sample report, fictional patient) · Location: Charlotte, North Carolina · Insurance: Medicare + supplement · Report date: November 1, 2026

1. What this condition is

The mitral valve is the door between the two chambers on the left side of your heart. In prolapse, one or both of its flaps (leaflets) bulge backward, and often a thin support cord has stretched or snapped, so blood leaks back with every beat; when the leak is severe, the heart enlarges over time to keep up. Surgery for this problem is done one of two ways: the surgeon repairs your own valve (reshapes it, replaces broken cords, adds a support ring) or replaces it with an artificial valve. The 2025 European heart valve guidelines (ESC/EACTS, published August 29, 2025) describe surgical repair as "the treatment of choice in operable patients when an optimal and durable result is expected" for severe primary mitral regurgitation, the group that prolapse belongs to, and say more complex repairs "should be attempted in experienced Heart Valve Centres" (2025 ESC/EACTS Guidelines, European Heart Journal). Repair rates differ between surgeons: in a national study of 28,507 mitral operations, the average surgeon repaired 41% of valves, with a range of 0% to 100%, and surgeons with more experience repaired more often (Bolling, STS database study summary). Your doctors will decide what applies to you; this report helps you prepare for those conversations.

Questions many patients and guidelines focus on:

• How often does this surgeon repair rather than replace a valve like mine? Few surgeons publish this. The public star ratings (below) combine repairs and replacements in one score, so this is a number you can only get by asking.
• Which "minimally invasive" approach would I get? The term means different things at different hospitals. In this report: Emory uses a surgical robot through small ports in the right side of the chest; Duke uses a small cut between the ribs on the right side (mini-thoracotomy); Mount Sinai uses a 7-8 cm cut over the lower breastbone, which still opens the bone.
• Does everyone who will bill me take Medicare? Medicare's own site says that with Original Medicare "you can use any doctor or hospital that takes Medicare, anywhere in the U.S.," and that you may pay more if a doctor doesn't accept assignment (Medicare.gov). At 62, Medicare usually comes through disability. Federal law generally does not require insurers to sell supplements before 65 (Medicare.gov), but North Carolina law (G.S. 58-54-45, effective January 1, 2020) makes Medigap Plans A, D and G available to people under 65 with Medicare, and premiums may be higher than at 65 (NC Department of Insurance). Ask your supplement company whether it pays its share for out-of-state surgery and for an assistant surgeon; NC's free Medicare counseling line (SHIIP) is 855-408-1212.

2. Specialists to consider

All three surgeons below lead programs on the 2026 Mitral Valve Repair Reference Center list run by the American Heart Association and the Mitral Foundation (2026 awardee list, page last updated Oct 20, 2026). To qualify, a hospital must do at least 50 repairs a year for prolapse-type valves, with at least one surgeon doing 25 or more (qualifications). Fair warning: the foundation's president is Dr. Adams, who is listed below; the list is still the only national one that singles out repair experience.

Public star ratings for mitral surgery, 2023-2025 (Society of Thoracic Surgeons, the surgeons' national registry; 3 stars = better than expected, 2 stars = as expected; programs choose whether to publish; the score mixes repair and replacement, so it is not a repair rate):

Ratings and counts from the STS Public Reporting participant pages for Duke, Emory, Mount Sinai, Sanger CMC, Sanger Pineville, Novant Charlotte, all read Nov 1, 2026.

The hospitals' own repair-rate claims quoted below (Emory ">99%", Mount Sinai ">99%" for prolapse-type valves) are self-reported, not audited, and not comparable between hospitals; the STS stars above are the only figures in this report that come from one national registry using one method.

1. Brittany Zwischenberger, MD and Jeffrey G. Gaca, MD — Duke's two named reference surgeons (in-state, about 140 miles from Charlotte)

• Where they practice now: Duke University Hospital, Durham, NC — both checked on the institution's own pages on November 1, 2026.
• Dr. Zwischenberger, Associate Professor of Surgery (her Duke page): lists heart valve disease and minimally invasive heart surgery, and says she performs minimally invasive surgery for "narrowed or leaky valves." Rating 4.85 out of 5 from 253 ratings; most recent review shown dated June 2026.
• Dr. Gaca, Associate Professor of Surgery (his Duke page): his areas lead with aortic valve surgery and transcatheter aortic valve replacement, with "Mitral Valve Disease" further down the list; his research covers transcatheter devices for the aortic, mitral and tricuspid valves. Rating 4.90 from 586 ratings; most recent review shown dated July 2026.
• Why selected:
• Both are named for Duke on the 2026 reference list. Dr. Zwischenberger is listed first here because her page centers on valve surgery for leaky valves and she appears on Duke's long-term results for 648 patients whose prolapse-type valves were repaired with one common technique (Journal of Cardiac Surgery, January 2025, on her Duke publication page). Ask either office which of the two does more prolapse repairs.
• Duke repaired 149 mitral valves and replaced 143 in 2023, and has averaged almost 300 mitral operations a year since 2015 (the hospital's own figures, including narrowed valves that usually need replacement, so not a prolapse repair rate) (Duke mitral valve page).
• Duke says it has done more than 1,750 minimally invasive mitral repairs since 1996 (the hospital's own figure, 2023 article) (Duke article), through a small cut between the ribs, not a robot.
• 3-star STS mitral rating, 634 mitral operations 2023-2025. Medicare is on the insurance list on both pages.
• Accepting new patients: yes, both (stated on each page).

2. Douglas A. Murphy, MD — Cardiac Surgeon, Professor (robotic repair; about 245 miles, roughly a 4-hour drive)

• Where they practice now: Emory Saint Joseph's Hospital, Atlanta, GA — checked on the institution's own page on November 1, 2026: Douglas A Murphy, MD - Atlanta, GA | Emory Healthcare. Page shows patient reviews dated September 2026.
• Why selected:
• His Emory page says he has performed over 2,000 robotic mitral valve operations and teaches his fully robotic approach to surgical teams worldwide (the hospital's own figure).
• Emory reports a repair rate of over 99% for prolapse-type valves and a death rate under 1%, "with most years achieving 0%" (the hospital's own figures, July 2025: self-reported, not audited, not comparable between hospitals) (Emory article by Emory's chief of cardiothoracic surgery).
• Emory says it has done more than 4,000 robotic mitral operations over 20 years and over 400 robotic heart operations a year (the hospital's own figures) (Emory robotic mitral page).
• Named reference surgeon for Emory Saint Joseph's on the 2026 list together with Michael E. Halkos, MD, Professor and Chief of Cardiothoracic Surgery at Emory. Dr. Halkos' Emory page (his Emory page, checked November 1, 2026) names robotic mitral valve surgery as an area of expertise, says he and Dr. Murphy lead the Saint Joseph's robotic program, shows reviews dated October 7, 2026, and says "Telehealth Visits Available." Same office, 404-778-7200: he is your second name at Emory.
• 3-star STS mitral rating for the Emory group, 962 mitral operations 2023-2025; the nearest program to Charlotte with fully robotic repair on the reference list.
• Accepting new patients: neither page says; see "Your first call" (Section 3).

3. David H. Adams, MD — Chair of Cardiovascular Surgery, Mount Sinai Health System (benchmark-level repair volume; a short flight)

• Where they practice now: The Mount Sinai Hospital, New York, NY — checked on the institution's own page on November 1, 2026: David H Adams - Cardiovascular Surgery | Mount Sinai. Page shows patient reviews dated July 2026 and industry disclosures for 2025-2026.
• Why selected:
• Mount Sinai states a current mitral repair rate above 99% with under 0.5% mortality, and says Dr. Adams and his team perform over 400 mitral operations a year (the hospital's own figures: self-reported, not audited, not comparable between hospitals) (Mount Sinai Mitral Valve Repair Center).
• In the New York State Department of Health's 2016-2018 public report, Mount Sinai says Dr. Adams performed 1,001 valve operations, more than any surgeon in the state, with a risk-adjusted death rate of 0.18% against a state average of 2.10% (as reported on the hospital's own page) (Mount Sinai outcomes page).
• Co-author of the leading textbook on valve repair; 3-star STS mitral rating, 975 mitral operations 2023-2025.
• Mount Sinai's "less invasive" approach is a 7-8 cm cut over the lower breastbone, not a robot or a side-of-chest cut (Mount Sinai minimally invasive page). The center says 2 or 3 of its surgeons work together on every patient; its team page (last updated July 24, 2024) names Drs. Anelechi Anyanwu, Percy Boateng, Ahmed El-Eshmawi and Robin Varghese. We did not check their individual pages. Ask how the second surgeon is billed (see Story 2).
• Accepting new patients: yes (stated on page).

Closer to home (North Carolina)

• Duke (Specialist 1) is your in-state reference center, about 140 miles from Charlotte.
• In Charlotte itself, no hospital is on the 2026 reference list. Both large Charlotte programs do mitral surgery and publish STS ratings (table above):
• Atrium Health Sanger Heart & Vascular Institute says it has dedicated surgical teams for areas such as mitral valve disease and offers open, minimally invasive and catheter-based mitral repair (Sanger cardiac surgery page). Its main Carolinas Medical Center group has 3 stars (157 mitral operations, 2023-2025). Atrium's 2023 Outcomes and Innovation Report says of its aortic valve and mitral repair programs: "John Frederick, MD and Larry Watts, MD lead these top-tier valve programs" (Sanger report, President's Letter); it does not say who leads which.
• Larry T. Watts, MD — Thoracic and Cardiac Surgery, Sanger Surgery Pineville and Kenilworth (Charlotte). His Atrium page, checked November 1, 2026, says he accepts new patients and shows reviews dated as recent as September 3, 2026 (his Atrium page). It lists no areas of focus, and we found no published mitral repair results by him; ask whether he does most of Sanger's mitral repairs.
• John R. Frederick, MD — Chief of the Division of Cardiovascular Surgery at Sanger. His Atrium page, checked November 1, 2026, says he accepts new patients and shows reviews dated as recent as September 1, 2026; it describes aortic valve and aortic surgery, not mitral repair (his Atrium page).
• Novant Health Heart & Vascular Institute launched a robotic mitral repair program, according to March 2026 local news (see "Leads"). Its Charlotte group has 2 stars (111 mitral operations, 2023-2025).
• For a Charlotte option, the first two questions in Section 7 let you compare either program's answers with the figures above.

Leads we checked and did not list

• Donald Glower, MD (Duke) — still featured in Duke's 2023 mitral article, but Duke's Heart newsletter reported his retirement in January 2026 (Duke Heart Pulse, Jan 11, 2026).
• Jeffrey Everett, MD (Novant Health, Charlotte) — local news in March and April 2026 says he leads Novant's new robotic mitral repair program (Hoodline, Mar 12, 2026; WBTV QC Life, Apr 17, 2026, sponsored segment). Novant's website blocked our check, and the program is too new for a multi-year record. A question for Novant: how many robotic mitral repairs has he done in total?
• Eric Skipper, MD (Atrium Sanger) — his Atrium page is live and accepts new patients, but does not list mitral repair.
• Cleveland Clinic (A. Marc Gillinov, MD), Johns Hopkins (James S. Gammie, MD) — on the 2026 reference list; not checked on their own institution pages for this report.

3. Next steps

How to reach each specialist (from each institution's own page):

• Duke: Dr. Zwischenberger 919-684-0125 · Dr. Gaca 919-613-5672 · Duke Heart new appointments within 48 hours: 919-681-5816. Duke's telehealth page offers specialist video visits if you are physically in North Carolina; for a new virtual or in-person appointment it gives 855-855-6484. Duke's hotel page lists hotels with a medical rate for patients (Concierge Services 919-684-5887).
• Emory Saint Joseph's (Drs. Murphy and Halkos): office 404-778-7200 · robotic mitral appointments 404-778-0175. Dr. Halkos' page says telehealth visits are available; ask whether a video visit works while you are in North Carolina.
• Mount Sinai (Dr. Adams): 866-648-7255 (866-MITRAL5) or the online appointment form · Dr. Adams' office 212-659-6820. Its records-review page (last updated November 1, 2023) asks you to call, then send your latest echo on CD with the written report (and any catheterization CD and report); the team reviews them before any consultation. An out-of-town page covers accommodations.
• Atrium Health Sanger (Charlotte): cardiac surgery appointments 704-373-0212 · Dr. Watts' Pineville office, new patients: 704-667-3840 · Atrium collects your history, labs and images before the first visit.
• Video visits and Medicare: Medicare.gov says that through December 31, 2027, Medicare covers telehealth from anywhere in the U.S., usually at the same cost as in person (Medicare telehealth). Confirm with the office that a remote visit or records review will be billed to Medicare.

Your first call — three questions (no page we checked answers all three):
1. Is the surgeon seeing new patients with mitral valve prolapse? Drs. Zwischenberger, Gaca, Adams, Watts and Frederick: pages say yes. Drs. Murphy and Halkos: pages do not say.
2. What is the wait for a first visit, and for surgery after that? No page gives a wait time.
3. Is a referral needed? No page states a referral rule.

Your 3 steps this week:

1. Ask your cardiologist's office for copies of your echocardiogram report and the images (and the TEE report, if you had the swallowed-probe echo), any heart catheterization or CT report, and your latest EKG. Ask them to write down which leaflet is prolapsing (front, back, or both) and whether a cord is torn. That one line decides which question you ask in step 2.
2. Call Duke and one other program above, ask the three questions in the box, and ask whether they will look at your echo images (by video visit or records review) before you travel.
3. Call your supplement company (or SHIIP, 855-408-1212): does it cover out-of-state surgery and an assistant surgeon? Then ask each program: "Do the hospital, the surgeon, the assisting surgeon and the anesthesiologist all accept Medicare assignment?"

4. Stories from families who have been there

These come from Adam Pick's HeartValveSurgery.com, a patient community where people post their own profiles (the site also runs hospital sponsorships). Each is one person's account, not a typical result.

1. Patient profile, robotic repair at Emory (Richard, retired and very active) — Chose Dr. Murphy for his experience and had robotic repair on April 13, 2021. An echo two days later showed a mild leak; a year and a half later, a TEE showed it was severe again. He was scheduled for a second operation and wrote that he was "somewhat apprehensive about the long-term outcome." Hard outcome: the repair did not last; the second operation's result is not posted. Profile
2. Patient guestbook, repair with Dr. Adams at Mount Sinai (Darlene, surgery July 2016) — Her incision was about 4 inches at the base of the breastbone, which she notes "Mount Sinai considers to be minimally invasive even though it is open chest surgery." Back to work in 6 weeks. A second surgeon billed her separately. Tone: grateful, practical. Guestbook
3. Patient profile, minimally invasive repair at Duke (Blue, surgery July 2021) — Felt "very well" three months after an 8-hour repair. Another surgeon had recommended valve replacement; the patient wrote that going that route "would have been a huge difference." (His Duke surgeon has since retired.) Profile

Hospital marketing (promotional, all positive): Mount Sinai patient stories.

What these stories add: a repair can fail and need a second operation (ask about re-operation rates); "minimally invasive" can still mean opening the breastbone; a second surgeon may bill you separately; and two surgeons can disagree on repair versus replacement for the same valve.

5. Ready-to-send messages

Email or patient-portal message to the surgeon's office (copy, fill the brackets, send):

Subject: New patient request — mitral valve prolapse, severe leak — records review
Hello, I am a 62-year-old man in Charlotte, North Carolina. My cardiologist told me I have severe mitral regurgitation from mitral valve prolapse ([front / back / both] leaflet, per my echo report) and that I need surgery.
Dr. [name]'s experience with mitral valve repair is why I am contacting your program. Could you tell me:
(1) whether Dr. [name] is seeing new patients with this condition, (2) the current wait for a first visit,
(3) whether a referral is needed, and (4) how to send my echo images and reports for review before a visit?
I would also like to know the surgeon's repair rate for valves like mine and how many mitral repairs the surgeon does per year.
My insurance is Original Medicare with a [plan letter] supplement. Thank you, [name, phone]

Phone script (what to say in the first 30 seconds): "Hi, I'm calling to request a new patient appointment with Dr. [name] for mitral valve prolapse with a severe leak. Is Dr. [name] currently seeing new patients with this condition? What's the wait? Do you need a referral, and how do I send my echo images before the visit? I have Original Medicare with a supplement; does the surgeon accept Medicare assignment?" Write down: the person's name, the date, the answer, the next step.

6. One-page summary to bring to the appointment

Print this page and fill it in before each visit.

• Condition: Mitral valve prolapse with severe mitral regurgitation (leaky mitral valve)
• Which leaflet (from your echo report): front (anterior) / back (posterior) / both · Torn cord (flail)? yes / no
• Heart pumping strength (ejection fraction, "EF"): ______ %
• Heart size (left ventricle size, if listed): ______
• Lung pressure (pulmonary artery pressure, if listed): ______
• Irregular heartbeat (atrial fibrillation)? yes / no · Other leaky valves (tricuspid)? yes / no
• Symptoms: short of breath on stairs / tired / swollen ankles / none
• Current medications and doses: ______________________________
• Other health conditions and past surgeries: ______________________________
• My 3 most important questions: 1. ______ 2. ______ 3. ______
• What I want from this visit: (example: "Know whether you can repair my valve, by which approach, and when.")
• Insurance: Original Medicare + supplement plan ____

7. Questions to ask the specialist

1. How many mitral valve repairs do you personally do each year? And your team? (A Mitral Foundation reference surgeon does at least 25 repairs a year for prolapse-type valves.)
2. What is your repair rate for my valve type? Ask by leaflet: "For [front / back / both]-leaflet prolapse like mine, what share do you repair rather than replace?" Front-leaflet and both-leaflet prolapse are usually harder to repair than back-leaflet.
3. How long is the wait for surgery?
4. If you start a repair and it doesn't look good on the heart ultrasound in the operating room, what happens: do you try again or replace? How often does that happen?
5. Which approach would you use for me (robot, small cut between the ribs, small cut over the breastbone, or full open) and why? Does the approach change my chance of repair?
6. In your patients, how many repairs need another operation within 10 years? What leak do you accept at the end of surgery?
7. Do I need anything else fixed at the same operation (atrial fibrillation treatment, closing the left atrial appendage, tricuspid repair)?
8. Who will do the key parts of the operation, and who else will bill me (assisting surgeon, anesthesia)? Do all of them accept Medicare assignment?
9. How many days in the hospital, when can I drive, and can cardiac rehab and follow-up echoes be done in Charlotte?
10. What warning signs should make me call you or go to the ER, before or after surgery?

8. Your support after this report

• 14 days of email questions about this report: reply to the delivery email.
• Day-30 check-in: we email you. If you could not get an appointment with any listed specialist, we research new options at no charge.
• Not helpful? Tell us within 7 days and we redo the research once at no charge; if it still doesn't help, we refund you in full.

This report is general information to help you find and talk to specialists. It is not medical advice, does not identify or confirm any condition, and does not recommend a treatment. Treatment decisions belong to you and your doctors. No doctor or hospital pays to be included in this report.