According to the latest guidelines from American Heart Association and American College ofCardiology, select patients qualify for early surgical intervention totreat mitral valve regurgitation. At the Cleveland Clinic, a recognizedleader in treatment of valvular heart disease, surgeons are able to repairmore than 99% of mitral valve prolapse using da Vinci Mitral Valve Repair,a minimally invasive, sternum-sparing procedure. The procedure is performedusing the da Vinci Surgical System, the world's only commercially availablerobotic platform for complex, minimally invasive surgery.

"Robotically assisted mitral valve repair is the best and least invasivetreatment for the majority of patients with a leaky mitral valve," said Dr.Mihaljevic. "Compared to valve replacement, mitral valve repair providesbetter long-term survival, better preservation of heart function, lowerrisk of complications, and usually avoids the need for long-term use ofblood thinners (anticoagulation)."

About the Condition

In patients who have mitral valve prolapse, the tissue of the mitral valveleaflets and chordae are abnormally stretchy, so that as the heart beats tocirculate blood, the mitral valve bows or flops back into the left atrium.Many patients with mitral valve disease are asymptomatic (have nosymptoms), even with a leak that is severe. When symptoms develop, theyinclude shortness of breath, fatigue, loss of energy, swelling of theankles and palpitations (extra or skipped heart beats).

Most patients diagnosed with mitral valve disease do not have any leaking(regurgitation) and do not require surgery. However, in about 10 to 15percent of people with mitral valve prolapse, there is a substantial leakand, surgery should be considered.

Surgeons can either replace the valve with a mechanical or biologicalvalve, or they can repair it using the patient's own tissue. Studiesdemonstrate that valve repair, which is facilitated by the da Vinci System,offers patients significant potential advantages over valve replacement.These advantages include reduced risk of surgical complications,(1) ahigher long-term survival rate,(2)(3)(4)(5) improved function and strengthof the heart,(1) more freedom from re-operation, fewer post-surgicalcomplications,(1) no need for life-long blood thinner medication and ashorter hospital stay.(1)

In the US alone, about 40,000 people have surgery to treat mitral valveregurgitation each year.(6) In 2006, Cleveland Clinic surgeons performed2,127 valve procedures -- 1,524 primary operations and 603 re-operations,the largest number of valve procedures in the U.S.

According to Drs. Gillinov and Mihaljevic, leaky mitral valves can berepaired rather than replaced in approximately 99% of patients, and nearly100% of patients receive a minimally invasive procedure if mitral valveprolapse is the cause of the leak.

"When a patient requires isolated mitral valve surgery for a degenerativevalve, at Cleveland Clinic we can perform the operation robotically orusing other minimally invasive techniques in nearly all cases," Dr.Gillinov said. "We offer several different minimally invasive approaches,including robotically assisted procedures, a small incision on the rightchest, or a small incision in the mid-line. Expertise with severalapproaches enables us to determine the best procedure for each patient,optimizing results."

About the Treatment

During traditional heart valve surgery, a surgeon will make an incisiondown the center of your sternum (breastbone) to get direct access to yourheart. The surgeon then repairs or replaces your abnormal heart valve orvalves. While this approach remains in use, today most patients withisolated valve disease can be treated with minimally invasive techniques.Minimally invasive surgery is a type of surgery performed through smallerincisions. This type of surgery reduces blood loss, trauma, and length ofhospital stay. There are two types of heart valve surgery: valve repairsurgery and valve replacement surgery. Valve repair allows the surgeon tofix your faulty heart valve, often without the use of artificial parts. Theadvantages of heart valve repair include a lower risk of infection,decreased need for life-long blood thinner medication and preserved heartmuscle strength. The mitral valve is the most commonly repaired valve, butthe aortic and tricuspid valves may also undergo some of these repairtechniques.

About the Surgeons

A.Marc Gillinov, MD, is a staff cardiac surgeon at the Cleveland ClinicHeart and Vascular Institute and is board-certified by the American Boardof Surgery and the American Board of Thoracic Surgery. He holds the JudithDion Pyle Chair in Heart Valve Research at Cleveland Clinic. Dr. Gillinovis a recognized expert in mitral valve repair surgery and in the study andtreatment of atrial fibrillation. He has particular expertise in roboticand minimally invasive mitral valve surgery. He has been instrumental inthe development of new, less invasive treatment approaches for mitral valvedisease and atrial fibrillation. He has delivered hundreds of invitedlectures at hospitals, academic meetings and seminars in the United Statesand abroad.

Tomislav Mihaljevic, MD, is a staff cardiac surgeon in the ClevelandClinic Department of Thoracic and Cardiovascular Surgery. He is certifiedby the American Board of Thoracic Surgery and the American Board ofSurgery. Dr. Mihaljevic specializes in minimally invasive cardiac surgery,robotically assisted cardiac surgery, valve repair and replacement,image-guided surgery and heart failure and cardiac transplantation. Dr.Mihaljevic's research has focused on minimally invasive cardiac surgery,robotically assisted cardiac surgery, real-time intraoperative functionalimaging for the assessment of myocardial injury and graft patency duringbeating heart surgery, intracardiac imaging systems and analysis of beatingheart intracardiac surgery, among other research studies. He has beeninvited to present his research at medical symposia and conferencesworldwide.

About Cleveland Clinic Heart and Vascular Institute

Cleveland Clinic Heart and Vascular Institute is the recognized worldleader in diagnosis and treatment of cardiovascular disease. ClevelandClinic has been ranked No. 1 in the nation for cardiac care by U.S. News &World Report every year since 1995. Cleveland Clinic has also been rankedamong America's Ten Best Hospitals every year since 1990 by U.S. News &World Report.

Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profitmulti-specialty academic medical center that integrates clinical andhospital care with research and education. Cleveland Clinic was founded in1921 by four renowned physicians with a vision of providing outstandingpatient care based upon the principles of cooperation, compassion andinnovation. U.S. News & World Report consistently names Cleveland Clinic asone of the national's best hospitals in its annual "America's BestHospitals" survey. Approximately 1,800 full-time salaried physicians andresearchers at Cleveland Clinic and Cleveland Clinic Florida represent morethan 100 medical specialties and subspecialties. In 2006, there were 3.1million outpatient visits to Cleveland Clinic. Patients came for treatmentfrom every state and from more than 80 countries. There were more than53,000 hospital admissions to Cleveland Clinic in 2006. Cleveland Clinic'sWeb site address is www.clevelandclinic.org.

About Intuitive Surgical, Inc.

Intuitive Surgical, Inc. (NASDAQ: ISRG), headquartered in Sunnyvale,California, is the global technology leader in the emerging field ofrobotic-assisted, minimally invasive surgery (MIS). Intuitive Surgicaldevelops, manufactures and markets robotic technologies designed to improveclinical outcomes and help patients return more quickly to active andproductive lives. The company's mission is to extend the benefits ofminimally invasive surgery to the broadest possible base of patients. Moreinformation is available at www.IntuitiveSurgical.com andwww.daVinciSurgery.com.Intuitive Surgical - Taking surgical precision beyond the limits of thehuman hand(TM)

About the da Vinci® Surgical System

The da Vinci Surgical System is a sophisticated robotic platform designedto enable complex surgery using a minimally invasive approach. The da VinciSystem consists of an ergonomic surgeon's console, a patient-side cart withfour interactive robotic arms, a high-performance vision system andproprietary EndoWrist® instruments. Powered by state-of-the-art robotictechnology, the da Vinci System is designed to scale, filter and seamlesslytranslate the surgeon's hand movements into more precise movements of theEndoWrist instruments. The net result is an intuitive interface withbreakthrough surgical capabilities. By providing surgeons with superiorvisualization, enhanced dexterity, greater precision and ergonomic comfort,the da Vinci Surgical System makes it possible for more surgeons to performminimally invasive procedures involving complex dissection orreconstruction. This ultimately raises the standard of care for complexsurgeries, translating into numerous potential patient benefits, includingless pain, a shorter recovery and quicker return to normal dailyactivities.

The presentation described is for general information only and is notintended to substitute for formal medical training or certification. Anindependent surgeon, who is not an Intuitive Surgical employee, providesprocedure descriptions. Intuitive Surgical trains only on the use of itsproducts and is not responsible for surgical credentialing or for trainingin surgical procedure or technique. As a result, Intuitive is notresponsible for procedural content. While clinical studies support the useof the da Vinci Surgical System as an effective tool for minimally invasivesurgery, individual results may vary. Intuitive®, da Vinci®, InSite®and EndoWrist® are registered trademarks of Intuitive Surgical, Inc.

Learn more about Mitral Valve Disease and view a preview for this programby visiting:http://www.or-live.com/daVinci/2272/index.cfm?cmpid=marketwire2272

VNR: Mitral Valve Repair

(1) Thourani VH, Weintraub WS, Guyton RA, et al. Outcomes and Long-Term Survival for Patients Undergoing Mitral Valve Repair Versus Replacement. Circulation. 2003;108:298-304 (Emory University Atlanta)(2) Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL: Valve repair improves the outcome of surgery for mitral regurgitation: a long-term study. Circulation. 1995; 91:1022-8(3) Enriquez-Sarano M, Schaff H, Frye R. Mitral Regurgitation: What Causes the Leakage Is Fundamental to the Outcome of Valve Repair. Circulation 2003;108:253-256.(Mayo Clinic Rochester)(4) Gillinov AM, Wierup PN, Blackstone EH, et al. Is Repair Preferable to Replacement for Ischemic Mitral Regurgitation? J Thorac Cardiovasc Surg 2001 Dec; 122(6):1125-41 (Cleveland Clinic)(5) Grossi E, Goldberg J, LaPietra A, et al. Ischemic mitral valve reconstruction and replacement: Comparison of long term survival and complications. J Thorac Cardiovasc Surg 2001 Dec; 122(6):1107-24 (NYU)(6) Intuitive Surgical-sponsored study on mitral valve repair and replacement. Document on file.

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