Michael Ibrahim, MD, MBBS, PhD
Kathleen Tierney had always lived life at full speed. Over a career that spanned over four decades, Tierney devoted her life to coaching, and later as an athletic administrator, serving as the athletic director of Bryn Mawr College. After 15 years at the Philadelphia-area school, she retired from her position in the summer of 2022.
In the midst of her bustling post-retirement routines of walking her dog and riding her bike, Tierney, who had made fitness a focus of both her personal and professional life, found herself extremely winded after exercise. Things only worsened from there. “I couldn’t even make it up a flight of stairs without having shortness of breath. My heart would feel like it was racing…then it would slow down. It was debilitating,” Tierney recalled.
Tierney made an appointment with a cardiologist who diagnosed her with atrial fibrillation, more commonly known as AFib. AFib- the most common type of heart arrythmia- happens when the electrical signals in your heart start misfiring. Instead of beating in a steady rhythm, the heart's upper chambers (the atria) start to quiver or flutter irregularly. When your heart is in AFib, the blood in the atria doesn't get pumped out properly. The Center for Disease Control and Prevention predicts that more than 12 million Americans will have AFib by the 2030.
Several tests were deployed to identify what factors were contributing to her Afib. The culprit? A faulty mitral valve, one of the heart’s four valves that assists with the timing and direction of blood flow. Her cardiologist referred her to Michael Ibrahim, MD, MBBS, PhD, director of Mitral and Reconstructive Valve Surgery at Penn Presbyterian Medical Center, who specializes in mitral valve surgeries, specifically with the use of robotics.
Tierney, who had already overcome breast cancer years before, was determined to conquer this new challenge and get her mitral valve fixed.
A Focus on Recovery
Ibrahim entered the scene with a solution to Tierney’s faulty mitral valve: robotic mitral valve repair.
“This type of surgery is the ultimate minimally invasive heart surgery. It allows maximal dexterity, visualization of the valve and handling of tissues with very small incisions,” said Ibrahim. The innovative procedure involved tiny 5mm incisions, eliminating the need for rib spreading.
Tierney embraced this opportunity, as recovery time with robotic surgery was typically much quicker, as the breastbone did not need to be broken to access the heart. The breastbone, Ibrahim says, can take six months to a year to fully heal, and in some patients, it never heals completely.
“Recovery was a real important factor for me going robotic. The robot was a lot easier. They didn’t need to crack my chest open. There are five small incisions under my right arm put where the robot went in,” she recalled.
In January of 2023, she arrived at Penn Presbyterian Medical Center for her surgery, confident and comfortable with what she was about to endure. “Dr. Ibrahim did a really good job of balancing out ego and humanistic approach. I felt like he really cared about me and about the outcome. He was so committed to this procedure after his years of experience conducting this type of surgery,” she said.
Ibrahim noted that Tierney needed a complex mitral valve repair, adding that "most people have disease affecting just one of the mitral leaflets, but Kathleen had severe degenerative disease of both the leaflets.”
“Another component we added was a Maze procedure. This is an ablation where we use high energy to create scars in the heart designed to reduce the chances of AFib.”
The use of robotics versus a traditional mitral valve surgery does not lead to any less time in the operating table, but Ibrahim says the robot allows more precision while conducting the surgery, and a much quicker recovery, as Tierney demonstrated, “I was in the intensive care unit for a day and a half, and was out of the hospital four days after the surgery,” she said. After a couple weeks of cardiac rehabilitation, she was well enough to resume her daily bike rides in the spring of 2023.
Ibrahim says this type of mitral valve robotic technology was developed about 15 years ago but has matured quickly within the past two to three years. Ibrahim, who joined Penn Medicine in 2015, has been a key player in growing the robotics program here. Already, he says, robotic mitral valve surgeries far outnumber the traditional mitral valve surgeries he performs. “My aim is to make our robotic mitral valve program the number one in the country,” he said.
Caring with Compassion
Tierney, now 66 –years old, describes her experience as a testament to the possibilities of modern medicine, guided by Ibrahim's steady hands and compassionate heart. “I feared that after being active my entire life, I was no longer going to be able to resume the life that I had envisioned for myself,” she said. “He was just so human and I connected with him in a way that surprised me. I truly trusted him.”
That connection is one that Ibrahim strives to have with each of his patients. “My brother had heart surgery when I was growing up, and communication from his care team to my family was lacking. I learned from that. People want to know the risks involved and I always tell them. But they also want to know that they are in experienced hands and that you are confident they will have a good outcome,” said Ibrahim.
As Tierney embarked on a cycling adventure through Ireland's breathtaking landscapes during the summer of 2023, she marveled at the journey she had undertaken. It’s a trip she didn’t think was possible a year ago; uncertain that she’d be able to live the active life she so desperately hoped for when she retired. But now thanks to Dr. Ibrahim and his team at Penn, with her heart in rhythm and her spirit unbound, she was now a living testament to the power of innovation, resilience, and the art of healing. “She is full of life and her care team were all motivated to get her back to living life at full speed,” says Ibrahim.